Knee balancing block

ABSTRACT

An orthopedic A/P cutting guide device, including a cut guide member, a support member and a positioning member for permitting both (i) rotational, and (ii) translational movement after the A/P cutting guide device has been attached to the distal femur by quick pins or other securing devices, is disclosed. Rotational movement may occur by loosening a knob thereby releasing the positioning member and the cut guide member from the support member, which may be fixed in position by the quick pins, and rotating the positioning member and the cut guide member together. Translational movement may occur by loosening a plurality of knobs thereby releasing the cut guide member from the support member and the positioning member, and moving the cut guide member anteriorly or posteriorly. After the device has been rotated and translated, the knobs may be tightened, thus securing the device from further movement.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/398,289, filed Jul. 23, 2002, and U.S. Provisional Application No.60/474,454 filed May 30, 2003, which are hereby incorporated byreference herein in their entireties, including but not limited to thoseportions that specifically appear hereinafter, the incorporation byreference being made with the following exception: In the event that anyportion of either of the above-referenced applications is inconsistentwith this application, this application supercedes said portion of saidabove-referenced applications.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

BACKGROUND OF THE INVENTION

1. The Field of the Invention

The present invention relates generally to orthopedic surgical devices,and more particularly, but not necessarily entirely, to a device andmethod for balancing flexion and extension gaps in total kneereplacement surgery, and for preparing the knee joint, to receive animplant.

2. Description of Related Art

The knee joint is comprised essentially of four bones, the fibula, thetibia, the femur, and the patella or knee cap. The two major bones,namely the proximal portion of the tibia and the distal portion of thefemur, articulate with one another forming the main articulation surfaceof the knee joint. More specifically, articulation between each condyleof the distal femur and the corresponding meniscus and condyle of theproximal tibia permits positioning of a patient's leg in both flexionand extension.

When a knee joint is damaged such that total knee arthroplasty (TKA) isrequired, resection of the proximal portion of the tibia and the distalportion of the femur is required to form an extension gap between saidproximal portion of the tibia and said distal portion of the femur whenthe patient's leg is in full extension. Additionally, a posteriorresection of the distal femur is required to form a flexion gap betweensaid proximal portion of the tibia and said distal portion of the femurwhen the patient's leg is in full flexion. In creating the extension andflexion gaps it is advantageous to resect the bones in such a manner soas to form equivalent rectangular gaps between the proximal portion ofthe tibia and the distal portion of the femur when the patient's leg isfully extended and flexed. In other words, each gap may be defined bycuts made in the proximal tibia and the distal femur that aresubstantially parallel to one another creating two rectangular gaps thatare substantially equivalent. It will be appreciated that a width of theextension gap may be substantially equivalent to a width of the flexiongap. These substantially equivalent rectangular gaps aid in creating thebalance in the knee that will ultimately allow the patient to both fullyflex and extend the leg.

In classic technique knee surgeries, the first portion of the surgery isusually the same, which essentially requires a surgeon to prepare theknee joint in a manner so as to create the extension gap. The extensiongap may be formed by making a distal cut in the femur using a distal cutguide to prepare the femur for further operative steps. It will beappreciated that this first portion of the surgery comprises severalindividual steps, which will be expounded upon hereinafter in moredetail. Each step aids in the placement of the distal cut guide on thedistal femur to create an accurate distal cut. The next portion of thesurgery comprises making a proximal cut on the tibia after which thechallenge becomes to create substantially equivalent rectangularextension and flexion gaps. It will be appreciated that additionalsurgical steps must be taken to implant the artificial knee joint and tocomplete the surgery, which steps will not be fully addressed herein.

It will be appreciated that in classic technique knee surgeries, used tobalance and prepare the knee joint to receive the prosthetic kneeimplant, the major steps of the procedure include the following: First,the distal femur is cut at a valgus angle, which is defined as the anglebetween the neutral mechanical axis of the limb and the anatomical axisof the femur, consistent with the valgus angle of the patient. Second,the proximal tibia is cut substantially perpendicular to the long axisof the tibia. Third, the ligaments are balanced while the knee joint isin extension so that there is a substantially rectangular extensionspace or gap. Fourth, the femur is sized based on the anterior andposterior dimensions of the distal femur using an A/P sizing guide. TheA/P sizing guide is placed on the distal femur by inserting two pinsinto the distal femur, attaching the A/P sizing guide to the distalfemur. Fifth, the A/P sizing guide is removed from the pins, and an A/Pcutting block is then positioned over the pins and onto the distalfemur. Sixth, the posterior cut is made in the distal femur, and the A/Pcutting block and the pins are removed from the bone. Seventh, a spacerblock is used to determine the equality of the flexion and extensiongaps. Eighth, the remaining cuts are finished, and then a trialreduction is performed.

It will be appreciated that the above surgical procedure is merely oneexample of the many techniques that have been used in the orthopedicindustry for knee replacement surgeries. It will be further appreciatedthat the above surgical procedure is not meant to be exhaustive, or evena summary, of the many surgical techniques that are used in theorthopedic industry to perform total knee replacement surgeries.

With many of the prior art knee balancing devices used in total kneereplacement surgeries, positioning of the knee balancing device dependsentirely on the placement of the pins in the distal femur. Such pinplacement requires great precision in order to properly place and locatethe knee balancing device on the femur. If the pins are not properlyplaced, the device will be mal-aligned on the distal femur. The surgeonmust then remove at least one of the pins from the distal femur, andre-secure the at least one pin to the bone for another attempt atsecuring the knee balancing device to the bone in an aligned position,which drastically increases the time and difficulty of the surgery. Theprior art knee balancing devices may also lead to over resection of thebones in the knee joint, as substantially equivalent rectangular gapsare sought, which may potentially cause problems if a later revisionsurgery becomes necessary.

Attempts have been made in the prior art to provide a device and methodfor locating the A/P cutting guide on the distal femur such that thedevice may be correctly placed and located on the distal femurinitially, without the necessity of removing the device and re-pinningthe device to the bone. For example, U.S. Pat. No. 5,364,401 (grantedNov. 15, 1994 to Ferrante et al.) discloses a system for resecting thedistal femur where various devices can be sequentially placed on a basemember having a pair of connected brackets that are axially and radiallyadjustable after being initially positioned on the bone. During a finalstage of bone preparation, the system utilizes a cutting block that maybe adjusted relative to its base. This device is characterized byseveral disadvantages, including the need to connect a complex series ofbrackets to a base creating a scaffolding to which several devices maybe removably attached.

U.S. Pat. No. 5,830,216 (granted Nov. 3, 1998 to Insall et al.)discloses a set of instruments for orientation of the femoral implant,including an epicondylar guide configured for referencing externalrotation from the epicondyles. The Insall et al. patent furtherdiscloses a posterior reference/rotation guide that can be attached tothe epicondylar guide for checking the rotation relative to the intactposterior condyles to confirm the epicondylar setting, and an A/Pcutting guide comprising a fin that is designed to fit into a slot cutin the distal femur so as to fix external rotation. The A/P cuttingguide can only move in the anterior and posterior directions for makingadjustments in the flexion and extension gaps. This device isdisadvantageous because there is no mechanism for adjusting the rotationof the A/P cutting guide, making each step in the surgery crucial,leaving little to no room for human error.

The present invention is directed to an orthopedic device for flexionand extension balancing in the knee joint by creating substantiallyequivalent rectangular flexion and extension gaps between the patient'sproximal tibia and distal femur. It is noteworthy that none of the priorart known to applicants provides an A/P cutting guide device that iseasy to operate, has few component parts and a relatively low profile,and that may be adjusted (i) translationally, in the anterior andposterior directions relative to at least one pin placed in the distalfemur, and (ii) rotationally, relative to the at least one pin placed inthe distal femur, to which the A/P cutting guide may be attached.

The prior art is thus characterized by several disadvantages that areaddressed by the present invention. The present invention minimizes, andin some aspects eliminates, the above-mentioned failures, and otherproblems, by utilizing the methods and structural features describedherein.

The features and advantages of the invention will be set forth in thedescription which follows, and in part will be apparent from thedescription, or may be learned by the practice of the invention withoutundue experimentation. The features and advantages of the invention maybe realized and obtained by means of the instruments and combinationsparticularly pointed out herein and in the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of the invention will become apparent from aconsideration of the subsequent detailed description presented inconnection with the accompanying drawings in which:

FIG. 1 is an exploded perspective view of an A/P cutting guide deviceillustrating a cut guide member, a support member, and a positioningmember made in accordance with the principles of the present invention;

FIG. 2 is a perspective view of the A/P cutting guide device of FIG. 1,assembled in accordance with the principles of the present invention;

FIG. 3 is a front view of the A/P cutting guide device of FIG. 1, madeand assembled in accordance with the principles of the presentinvention;

FIG. 3A is side view of the A/P cutting guide device of FIG. 3, made inaccordance with the principles of the present invention;

FIG. 3B is a back view of the A/P cutting guide device of FIG. 3, madein accordance with the principles of the present invention;

FIG. 3C is a cross-sectional view of the A/P cutting guide device takenalong the line A-A of FIG. 3A;

FIG. 4 is a front view of the A/P cutting guide device located on adistal end of a femur in a flexed knee joint, with the knee joint inflexion, and illustrates the A/P cutting guide device in mal-alignmentwith a resected portion of a proximal tibia;

FIG. 5 is a front view of the A/P cutting guide device located on thedistal end of the flexed femur, similar to FIG. 4, with the A/P cuttingguide device having been rotated into alignment, in accordance with theprinciples of the present invention;

FIG. 6 is a perspective view of the distal end of the femur illustratinga surgeon beginning to drill a hole parallel to a shaft of the femur;

FIG. 7 is a front view of the bones that comprise a natural knee joint,illustrating a valgus angle of the knee joint, a neutral mechanical axisof the limb, and an anatomical axis of the femur;

FIG. 8 is a front view of a distal cut guide located on the distal endof the femur for making an initial distal cut of the femur, inaccordance with the principles of the present invention;

FIG. 9 is a perspective view of the cut guide of FIG. 8, illustratingthe placement of a plurality of quick pins securing the cut guide to thedistal femur;

FIG. 10 is a front view of the tibia with a tibial alignment guide, atibial cut guide and a tibial stylus located thereon;

FIG. 11 is a perspective view of the proximal tibia illustrating thespecifics of the tibial cut guide and tibial stylus;

FIG. 12 is a perspective view of the proximal tibia illustrating anoscillating saw resecting the proximal tibia;

FIG. 13 is a top, front view of an A/P sizing guide located on thedistal end of a typical femur after the initial distal cut has beenmade, wherein an epicondylar axis is illustrated;

FIG. 14 is a top, front view of the A/P sizing guide similar to FIG. 13,illustrating the placement of the A/P sizing guide on an atypical femur,specifically illustrated is a hypoplastic lateral femoral condyle;

FIG. 15 is a perspective view of a plurality of quick pins that havebeen secured to the distal femur, to which the A/P cutting guide devicewill be secured, in accordance with the principles of the presentinvention;

FIG. 16 is a top, front view of several different size representationsof the A/P cutting guide device, illustrating the relationships of thediffering sizes of the A/P cutting guide devices;

FIG. 17 is a side view of the A/P cutting guide device located on thedistal end of the femur, illustrating the knee joint in flexion with aspacer block located in a flexion gap formed between the distal femurand the proximal tibia, with an alignment rod positioned for verifyingappropriate alignment of the knee;

FIG. 18 is a back view of the spacer block located in an extension gapformed between the distal femur and the proximal tibia, illustrating theknee joint in extension with two alignment rods connected to the spacerblock and positioned for assessing the overall alignment of the knee;and

FIG. 19 is a front view of the spacer block in relation to a tibialpolyethylene insert, a tibial tray, and a femoral component.

DETAILED DESCRIPTION OF THE INVENTION

For the purposes of promoting an understanding of the principles inaccordance with the invention, reference will now be made to theembodiments illustrated in the drawings and specific language will beused to describe the same. It will nevertheless be understood that nolimitation of the scope of the invention is thereby intended. Anyalterations and further modifications of the inventive featuresillustrated herein, and any additional applications of the principles ofthe invention as illustrated herein, which would normally occur to oneskilled in the relevant art and having possession of this disclosure,are to be considered within the scope of the invention claimed.

Applicants have discovered that a total knee arthroplasty (TKA) isgreatly enhanced by utilizing a unique A/P cutting guide device 10 thatmay be moved in both a rotational and translational manner with respectto a distal end of a femur after the A/P cutting guide device 10 hasbeen secured, or pinned, to the distal femur. Applicants have thusconceived of a method for utilizing the unique A/P cutting guide device10 during TKA surgeries.

The A/P cutting guide device 10 of the present invention may beconfigured and dimensioned to be placed on a substantially flat,previously resected distal femur. It should be noted that the A/Pcutting guide device 10 will be particularly described herein inconjunction with the knee joint and particularly for resecting aposterior portion of the distal femur.

In classic technique knee replacement surgery, the first part of thesurgery is essentially the same, and requires a surgeon to make twopreliminary cuts, one cut on the distal femur and the other cut on theproximal tibia. It will be appreciated that the distal femoral cut maybe made prior to the proximal tibial cut, or vice-versa, withoutdeparting from the scope of the present invention. Therefore, while thepresent invention may be described herein performing the distal femoralcut before the proximal tibial cut, it will be appreciated that such asequence is not required.

It will further be appreciated that each cut requires several individualsteps to accomplish the result, wherein the first cut results in aresection of the distal most portion of the femur, or a resection ofboth femoral condyles, creating a substantially flat, resected surfaceon the distal femur. A similar procedure performed on the proximal tibiaresults in the resection of the proximal most portion of the tibia, or aresection of the tibial plateau, creating a substantially flat, resectedsurface on the proximal tibia. After the distal femoral cut and theproximal tibial cut have each been made, a gap is formed between the cutportions of the distal femur and proximal tibia. When the knee is fullyextended, this gap may be referred to as an extension gap 16(illustrated best in FIG. 18). Soft tissue releases are then performedto make a substantially rectangular gap. When the knee is flexed, a gapcreated between the posterior portion of the distal femur and theproximal tibia may be referred to as a flexion gap 18 (illustrated bestin FIG. 17). It is advantageous for the surgeon to create substantiallyparallel femoral and tibial cuts such that the extension and flexiongaps 16, 18 are each substantially equivalent and rectangular in shape.

Referring now to the device 10 of the present invention, FIG. 1illustrates the A/P cutting guide device, generally referred to as item10, in an exploded, perspective view. It will be appreciated that theA/P cutting guide device 10 may generally comprise a cut guide member20, a positioning member 30, for example a positioning plate asillustrated in FIG. 1, a support member 40, and a boom 50. Each of theabove components will be described herein in more detail below. Itshould be noted that the above components may be manufactured frommartistic grade stainless steel, or any suitable biocompatible materialthat has been developed for manufacturing surgical instruments andtools. For example, other materials that exhibit similar strengthproperties to stainless steel may be used to manufacture the abovecomponents so long as the materials may be developed and manufacturedinto surgical instruments and tools.

It should be noted at the outset that after the initial distal femoralcut and proximal tibial cut are each made, quick pins 150 and 152, alsoreferred to herein as securing members 150 and 152 (illustrated best inFIG. 15), or other securing devices may be placed in the resectedsurface of the distal femur to secure a sizing guide 60 (illustratedbest in FIGS. 13 and 14) to the distal femur. The sizing guide 60 may beconfigured for sizing the distal femur, such that an appropriately sizedfemoral component may be selected by the surgeon. The sizing guide 60may be located on the substantially flat, resected surface of the distalfemur and may be secured to said substantially flat, resected surface bythe quick pins 150 and 152. It will be appreciated that the quick pins150 and 152 are initially implanted to secure the sizing guide 60, butwill later be used as a reference to secure other components of theinvention to the bone. For example, the sizing guide 60 and subsequentplacement of the quick pins 150 and 152 determine the initial positionof the A/P cutting guide device 10 on the distal femur, as the A/Pcutting guide device 10 will be secured to said quick pins 150 and 152.After securing the A/P sizing guide 60 to the distal femur, ameasurement may be taken utilizing the A/P sizing guide 60, whichmeasurement may correspond to an appropriately sized femoral component,and may further correspond to the A/P cutting guide device 10.

After the quick pins 150 and 152 are placed in the bone, andmeasurements from the sizing guide 60 taken, the sizing guide 60 may beslid off and removed from the quick pins 150 and 152. Thereafter, theA/P cutting guide device 10 may be slid onto the quick pins 150 and 152.As will be explained herein in more detail below, the A/P cutting guidedevice 10 may move relative to the quick pins 150 and 152, which may befixed to the distal femur.

As illustrated in FIGS. 1-3, the cut guide member 20, also referred toherein as a cutting block 20, a cutting block member 20, and sometimesreferred to herein in conjunction with its features as a means fortranslating the device 10, may comprise a top surface 20 a, a bottomsurface 20 b, a face 20 c, a connecting portion 21, and a recessed area22. It will be appreciated that the recessed area 22 may be defined bysidewalls 23, an anterior border 28 and a posterior border 29, and arecessed surface 22 a. The connecting portion 21 may extend upwardlyfrom the top surface 20 a of the cut guide member 20, as illustrated inFIG. 1. Connecting portion 21 may have an opening 27 configured toreceive and secure the boom 50 to the cut guide member 20.

The boom 50 may comprise a first end 51 and a second end 52, the firstend 51 of said boom 50 being dimensioned to fit within the opening 27 ofthe connecting portion 21 of the cut guide member 20, and may beconfigured as a reference to aid the surgeon in making an anterior cutin the distal femur. The boom 50 may further act to aid the surgeon inthe avoidance of notching the femur. As used herein, “notching” refersto cutting too much of the bone, in other words over resecting a portionof the bone, such that a notch or depression is created in the bone.Notching the femur tends to create edges that cause stress risers, whichhave potential to cause fractures in the bone. Therefore, the boom 50helps to reduce the occurrence of stress risers, due to notching theanterior portion of the distal femur, by acting as a reference point forthe surgeon such that over resection may be avoided when making theanterior cut in the distal femur.

As illustrated in FIG. 1, the opening 27 of the connecting portion 21may be substantially circular, but it will be appreciated that theopening 27 may be any shape to enable one end 51 of the boom 50 to fitattachably within the opening 27. It will likewise be appreciated thatthe boom 50 may be modified to be of any suitable shape having across-section that includes a substantially circular shape, asillustrated, or a substantially square shape, a substantially polygonalshape, or any other suitable shape that may be designed for use as theboom 50.

The recessed surface 22 a of the recessed area 22 of the cut guidemember 20 may comprise a plurality of holes, represented by items 24 and26, that are each defined by a sidewall. As illustrated best in FIG. 3B,the holes 24 and 26 may be substantially elongated and straight,continuing in the same direction without curving, or the holes 24 and 26may curve slightly such that a substantially kidney bean shape may beachieved, or the holes 24 and 26 may curve in a substantially arcuatemanner. Of course, it will be appreciated that other substantiallyelongated shapes for the holes 24 and 26 may also be used withoutdeparting from the scope of the present invention.,

Recessed area 22, as illustrated in FIGS. 1 and 2, may be shaped in asubstantially rectangular manner. However, it will be appreciated thatthe shape of the recessed area 22 may be modified such that any suitableshape may be utilized, including a substantially square shape, anysuitable substantially polygonal shape, any suitable substantially ovalshape, or any suitable substantially elongated shape. Because of therelationship that exists between the cut guide member 20 and therecessed area 22, it will be appreciated that as the shape or size ofthe cut guide member 20 is modified, the shape or size of the recessedarea 22 may also be modified accordingly, although such modification isnot necessarily required. Recessed area 22 may be configured anddimensioned to receive the support member 40 and a portion of thepositioning member 30 therein. Therefore, it is to be understood that asthe support member 40 and the positioning member 30 are modified, theshape of the recessed area 22 may also be modified in order to maintainthe function of the recessed area 22.

The sidewalls 23 of the recessed area 22 may each comprise a wallsurface, represented by items 23 a and 23 b, and the wall surfaces 23 aand 23 b may be raised with respect to the recessed surface 22 a, andmay be recessed with respect to the face 20 c of the cut guide member20. The wall surfaces 23 a and 23 b may be located medially andlaterally on each side of the recessed surface 22 a on the cut guidemember 20. The anterior border 28, the posterior border 29, and the wallsurfaces 23 a and 23 b define a translation area, illustrated best inFIG. 2 by bracket 15, that may be configured to receive at least aportion of the positioning member 30 therein. It will be appreciatedthat the cut guide member 20 may be moved in a translational manner, aswill be discussed below in more detail, only as far as the translationarea 15 will allow. In other words, it is possible that as the cut guidemember 20 moves in the translational manner, at least a portion of thepositioning member 30 may ultimately contact the anterior border 28 orthe posterior border 29 of the translation area 15, limiting how faranteriorly or posteriorly the cut guide member 20 may be moved withinthe translation area 15. However, it will be appreciated that thepositioning member 30 is not required to contact the anterior border 28or the posterior border 29, but those borders serve to limit how faranteriorly or posteriorly the cut guide member 20 may move before thepositioning member 30 contacts one of the above-referenced bordersduring translation.

It will be appreciated that the walls 23 may join the anterior border 28or the posterior border 29 at a junction forming a corner 23 c. It willfurther be appreciated that the corners 23 c of the recessed area 22 maybe substantially round. It should be noted that rounded corners 23 c maybe present at each of the junctions where the walls 23 meet the anterioror posterior borders 28 and 29, but the invention may still operate andfunction using corners 23 c that are not rounded. For example, corners23 c that substantially form right angles at the junction of the walls23 may be used as long as the function of the corners 23 c ismaintained. The function, at least in part, of said corners 23 c is topermit protruding walls 31 and 33 of the positioning member 30 to rotatewithin the recess 22 and move about the walls 23 and the corners 23 c,as illustrated best in FIG. 3C.

As illustrated in FIGS. 3A-3C, the cut guide member 20 may furthercomprise an anterior portion, represented by the bracket numbered asitem 25 in FIG. 3A, and a posterior portion, represented by the bracketnumbered as item 25 a in FIG. 3A. The anterior portion 25 may comprisean anterior cutting guide 140 configured as a template for a cuttinginstrument 350, such as an oscillating saw (as illustrated in FIG. 12),to enter therein and make an anterior cut in the distal femur. Theanterior cutting guide 140, as illustrated, may be essentially a slitformed within the cut guide member 20 so as to permit the cuttinginstrument 350 to enter therein. The anterior cutting guide 140 mayslope downwardly from back 144 to front 145, and in a proximal to distaldirection, of the cut guide member 20, as illustrated in FIG. 3A, suchthat the resulting anterior cut may be similarly sloped. It will beappreciated that the slope of the anterior cutting guide 140 may be asillustrated, or it may modified by one of skill in the art to include agreater or lesser slope angle depending upon the desired outcome of theresulting anterior cut to be made in the bone. As illustrated, theanterior cutting guide 140 slopes such that the resulting anterior cutlines-up approximately with the second end 52 of the boom 50, which mayact as a reference for the surgeon.

The posterior portion 25 a of the cut guide member 20 may comprise aposterior cutting guide 142 configured as a template for making aposterior cut in the distal femur using the cutting instrument 350, suchas the oscillating saw mentioned above. The posterior cutting guide 142,as illustrated, may be a bottom edge 143 of the cut guide member 20.However, it will be appreciated that the posterior cutting guide 142 maybe some other surface besides the bottom edge 143 of the cut guidemember 20 as long as the surface can be rotated and translated, and thesurface acts as a cutting guide permitting the surgeon to make theposterior cut in the distal femur. The posterior cutting guide 142 maycomprise a substantially flat surface that may enable the surgeon toplace the cutting instrument 350 in contact with the substantially flatsurface of the posterior cutting guide 142, and to make a cut that issubstantially straight and flat. The substantially straight, flatposterior cut is a cut that may advantageously be formed substantiallyparallel to the proximal tibial cut creating the flexion gap 18. FIG. 5illustrates the A/P cutting guide device 10 in proper position andalignment on the distal femur, with the patient's leg in flexion, priorto the surgeon committing to the posterior cut, such that the posteriorcut if made with the A/P cutting guide device 10 in this position willresult in the flexion gap 18 being substantially rectangular in shape,such that an upper side 18 a of said gap 18 is substantially parallel toa lower side 18 b of said gap 18 (as shown most clearly in FIG. 17).Stated in another way, the distance represented by bracket A′ may besubstantially equal to the distance represented by bracket B′ indicatingthat the lines a′-a′ and b′-b′ are substantially parallel.

It should be noted that the posterior cutting guide 142 may be locatedon the bottom edge 143 of the cut guide member 20 as described above,but it should be noted that a posterior cutting guide 142 located inanother location within the cut guide member 20 and having the same or asimilar function as the posterior cutting guide 142 may also be used bythe present invention as long as the rotational and translationalcapabilities of the device 10 are not interfered with.

As mentioned above, the cut guide member 20 may be configured to slideonto the quick pins 150 and 152 by utilizing holes 24 and 26, and may besecured to the quick pins 150 and 152 by utilizing both the supportmember 40, and the positioning member 30, as explained in more detailbelow. Support member 40 may comprise a plurality of through holes 46and 48 for receiving the quick pins 150 and 152 therein in a tightmatching fit, thus securing and fixing the support member 40 to thequick pins 150 and 152. It should be noted that the shape of throughholes 46 and 48 may be configured to match the shape of the quick pins150 and 152 or other securing device. Once attached to said quick pins150 and 152, the support member 40 may be in a position of stability andmay be fixed to the distal femur. Thus, the support member 40 may act asan anchor to secure the entire A/P cutting guide device 10 to the distalfemur.

Support member 40, sometimes referred to herein as a first member, mayfurther comprise a plurality of protrusions 42 and 44 that protrude fromboth a first side 43 and a second side 45 of the support member 40 asillustrated in FIG. 1, and may surround through holes 46 and 48 suchthat when the quick pins 150 and 152 are inserted into the through holes46 and 48, the protrusions 42 and 44 may also surround the quick pins150 and 152. It will be appreciated that while the present inventionillustrates the protrusions 42 and 44 surrounding the through holes 46and 48 such is not required. Protrusions 42 and 44 may be provided onthe medial and lateral sides of a central through hole 41 forinteracting with a plurality of through holes 32 and 34 of thepositioning member 30, and may further interact with the holes 24 and 26of the cut guide member 20. It should be noted that the interaction ofthe protrusions 42 and 44 with holes 32, 34, 24 and 26 may permit thepositioning member 30 and the cut guide member 20 to move about theprotrusions 42 and 44, and hence the quick pins 150 and 152, as thequick pins 150 and 152 extend through the protrusions 42 and 44.

The support member 40 may comprise an outer wall surface 47, a first end49 a, and a second end 49 b. The support member 40 may comprise across-sectional shape that may be substantially shaped as a diamond suchthat the outer wall surface 47 may taper from middle reference areas 49and 49 c in the medial and lateral direction toward the first end 49 aand the second end 49 b, as illustrated in FIG. 1. The first end 49 aand the second end 49 b may be polygonally shaped such that asubstantially rounded configuration may be achieved as illustrated inFIG. 1, or a truly rounded configuration may also be used withoutdeparting from the scope of the present invention. The tapering of theouter wall surface 47 may result in a height of the support member 40,as measured between the top reference area 49 and the bottom referencearea 49 c, that may be greater than the height of the support member 40at either of its ends 49 a and 49 b.

It will be appreciated that as used herein the term “support member” mayrefer to: (a) a first body having at least one point, or a defined area,that acts as a hinge, or a point or area of support, about which asecond body may be caused to rotate, revolve or turn; or (b) a firstbody having a surface about which a second body may move, with respectto the first body, in which every point of the second body movesparallel to and the same distance as every other point of said secondbody. It should be noted that the support member 40 may be shaped asillustrated in FIG. 1, or the shape may be modified to include asubstantially oval shape, a substantially elongated shape, or any othersuitable shape for utilization as a support about which other componentsof the invention may move. Thus, the support member 40 may be fixed tothe quick pins 150 and 152 providing a stationary piece about which thepositioning member 30 and cut guide member 20 may move, relative to thequick pins 150 and 152 and the distal femur.

The positioning member 30, sometimes referred to herein as a secondmember, and sometimes referred to in conjunction with its features as ameans for attaching the cut guide member 20 to the support member 40,illustrated in FIGS. 1-3, may generally comprise a first end 30 a, asecond end 30 b, a plurality of through holes 32 and 34, a plurality oftranslational through holes 36 and 38, and a central hole 39. It will beappreciated that the placement of the holes 32, 34, 36, 38, and 39 onthe positioning member 30 may be as illustrated in the FIGS., or thepositioning member 30 may be modified to include holes 32, 34, 36, 38,and 39 placed in different locations on said positioning member 30without departing from the scope of the present invention. It will beappreciated that at least one of the plurality of through holes 32 and34 may be located at or near the first end 30 a and at the second end 30b of the positioning member 30. It will be appreciated that theplurality of through holes 32 and 34 may be substantially kidney beanshaped, or may be shaped in a substantially arcuate manner (illustratedbest in FIG. 3), while the translational through holes 36 and 38(illustrated best in FIG. 1) may be substantially elongated and permitlateral knobs 110 and 112 to pass therethrough, and the central hole maybe configured for allowing the passage of a central knob 100therethrough (illustrated best in FIG. 1). It will be appreciated thatthe shape of the through holes 32, 34, 36, and 38, and the shape of thecentral hole 39 may each be modified to be a substantially elongatedshape, a substantially circular shape, a substantially square orrectangular shape, a substantially polygonal shape, or any othersuitable shape known in the art, without departing from the scope of thepresent invention. It will further be appreciated that the through holes32, 34, 36, and 38, and the central hole 39 may each be similarly shapedto one another, or they may each have their own unique shape withoutdeparting from the scope of the present invention.

Positioning member 30 may further comprise a first side 72, a secondside 74, a top surface 76, a bottom surface 78, and a series of markings102 located on the first side 72 and near at least one of the throughholes 32 and 34. The series of markings 102 may correspond to apredetermined angle of rotation of the positioning member 30. Thepositioning member 30 may also comprise a plurality of protruding walls31 and 33 protruding from the second side 74 of the positioning member30. It will be appreciated that the protruding walls 31 and 33 may alsoextend outwardly from the second side 74 of the positioning member 30 ina substantially orthogonal manner.

It will be appreciated that protruding walls 31 and 33 may correspond inshape to the walls 23, including the corners 23 c, of the cut guidemember 20 such that the outer portions of the Protruding walls 31 and 33may fit into and match the walls 23 of the cut guide member 20. Theouter portion of the protruding walls 31 and 33 may be shapedsubstantially in a convex manner, and the inner portion of theprotruding walls 31 and 33 may be substantially shaped in a concavemanner in order to allow the positioning member 30 to rotate about thesupport member 40. Thus, the protruding walls 31 and 33 may be shaped ina substantially arcuate manner as described above.

It will be appreciated that the concavity of the inner portions of theprotruding walls 31 and 33 may be such that the ends 49 a and 49 b ofthe support member 40 may articulate with the concave inner portions ofthe protruding walls 31 and 33 as the positioning member 30 rotatesabout said support member 40. It will further be appreciated that as theshape of the walls 23 of the cut guide member 20 changes, the protrudingwalls 31 and 33 may change accordingly such that the functions statedabove may be accomplished.

Central knob 100, also referred to herein as an attachment member 100,and collectively referred to herein with its associated parts andfeatures as a means for rotating, may comprise a knob portion 104 havingan opening 106 formed therein, and a pin portion 108 configured anddimensioned for being inserted through the central hole 39 of thepositioning member 30 and into the central hole 41 of the support member40. It will be appreciated that pin portion 108 may comprise threads forthreadedly engaging the central holes 41 of the support member 40, whichmay also be threaded. However, it will be appreciated that such athreaded configuration is not required, and the connection between thepin portion 108 and the central hole 41 may be modified to include otherfastening mechanisms known in the art to secure a pin portion, such as108, to a hole, such as 41. For example, pin portion 108 may ultimatelybe secured to the support member 40 by way of a fastener 109, whether ornot the pin portion 108 and the central hole 41 are threaded, whichfastener 109 may be a nut for example, or said fastener 109 could be anyother fastening device currently known in the art, or which may becomeknown in the future, for securing the pin portion 108 to the supportmember 40.

Opening 106 of the knob 100 may be configured and dimensioned forreceiving an instrument therein to provide the mechanism to secure theknob 100 to the support member 40. It will be appreciated that opening106 may be substantially polygonal in shape, substantially hexagonal forexample, or may be any suitable shape for receiving said instrumenttherein and otherwise accomplishing the stated function. It will befurther appreciated that the knob portion 104 may have a cross-sectionalshape that may be substantially star shaped as illustrated in FIGS. 1-3,or it may be substantially circular in shape as illustrated in FIGS. 4and 5, or it may be substantially oblong, substantially square,substantially polygonal, or any other suitable shape for tightening andloosening the pin portion 108. It will be further appreciated that thepin portion 108 may be configured without threads as illustrated in FIG.1, or it may comprise threads thereon for attachment to the central hole41, or to the fastener 109, in a screwing manner. Therefore, the pinportion 108 may be, for example, threaded and function similar to a boltand nut, or it may be unthreaded having other means for securing the pinportion 108 to the fastener 109.

Similar to the knob 100, lateral knobs 110 and 112, also referred toherein as attachment members 110 and 112, may each comprise a knobportion 118 and 120 having an opening 114 and 116 formed therein, and apin portion 122 and 124. Pin portions 122 and 124 may be configured anddimensioned for insertion through the translational through holes 36 and38 of the positioning member 30, passing near, but not through, theholes 46 and 48 of the support member 40, and into the lateral throughholes 130 and 132 of the cut guide member 20 such that the positioningmember 30 and the cut guide member 20 may sandwich the support member 40therebetween. It should be noted that the lateral through holes 130 and132 may also be referred to herein as receiving holes 130 and 132 forreceiving attachment members 110 and 112 therein. It will be appreciatedthat pin portions 122 and 124 may comprise threads for threadedlyengaging the lateral through holes 130 and 132, which may be threaded.However, it will be appreciated that such a threaded configuration isnot required, and may be modified to include other fastening mechanismsknown in the art to secure a pin portion, such as 122 and 124, to athrough hole, such as 130 and 132.

For example, pin portions 122 and 124 may be ultimately secured to thecut guide member 20 by way of fasteners 123 and 125, whether the pinportions 122 and 124 and the through holes 130 and 132 are threaded ornot. Fasteners 123 and 125 may be for example a nut, or any otherfastening device that may hold or secure the pin portions 122 and 124 inplace, whether threads have been utilized or not, thus allowing thelateral knobs 110 and 112 to essentially secure the positioning member30 to the cut guide member 20.

Openings 114 and 116 of the attachment members 110 and 112,respectively, may be configured and dimensioned for receiving aninstrument therein to provide the mechanism to secure the attachmentmembers 110 and 112 to the receiving holes 130 and 132 of the cut guidemember 20. Openings 114 and 116 may be substantially polygonal in shape,substantially hexagonal for example, or may be any suitable shape forreceiving the instrument therein and for otherwise accomplishing thestated function. It will be appreciated that the knob portions 118 and120 may be substantially circular in shape as illustrated in FIGS. 4 and5, or may be substantially star, substantially oblong, substantiallysquare, substantially polygonal, or any other suitable shape fortightening and loosening the pin portions 122 and 124. It will befurther appreciated that the pin portions 122 and 124 may be configuredwithout threads as illustrated in FIG. 1, or may comprise threadsthereon for attachment to the lateral through holes 130 and 132, or thefasteners 123 and 125, of the cut guide member 20 in a screwing manner.

Assembly of the cut guide member 20, the positioning member 30, and thesupport member 40 may be accomplished in the following manner. First,position the cut guide member 20 over the quick pins 150 and 152 byplacing the quick pins 150 and 152 through the holes 24 and 26 restingthe cut guide member 20 on the substantially flat, resected surface ofthe distal femur.

Second, the support member 40 may be positioned on the quick pins 150and 152 by inserting the quick pins 150 and 152 through the holes 46 and48. The protrusions 42 and 44 on the second side 45 of the supportmember 40 may be positioned within the holes 24 and 26 of the recessedsurface 22 a of the cut guide member 20, allowing the support member 40to rest within the recessed area 22 of the cut guide member 20. At thispoint, the support member 40 may be fixed to the quick pins 150 and 152due to the matching fit between the holes 46 and 48, and said quick pins150 and 152.

Third, the positioning member 30 may be placed over the quick pins 150and 152 permitting the quick pins 150 and 152 to protrude through theholes 32 and 34. The protruding walls 31 and 33 may be inserted into therecessed area 22 such that the protruding walls 31 and 33 may engage thewalls 23, including the corners 23 c, if necessary, of the cut guidemember 20 such that the support member 40 may be sandwiched between thecut guide member 20 and the positioning member 30. At this stage ofassembly, the protrusions 42 and 44 on the first side 43 of the supportmember 40 may be positioned within the holes 32 and 34.

Last, assembly of the A/P cutting guide device 10 on the quick pins 150and 152 may be completed by tightening the knob 100, by inserting thepin portion 108 through the hole 39 of the positioning member 30 andinto the hole 41 of the support member 40, and securing the device 10via the pin portion 108 and the fastener 109. The knob 100 may be thusfirmly seated within the fixed support member 40, maintaining the A/Pcutting guide device 10 from rotating while said knob 100 is securelyfastened to the support member 40. The pin portions 122 and 124 of theknobs 110 and 112 may be inserted into the translational through holes36 and 38 and into the lateral through holes 130 and 132 of the cutguide member 20, thus securing the cut guide member 20 to thepositioning member 30. It will be appreciated that positioning member 30may have been previously fixed to the support member 40 by the knob 100.The attachment of the knobs 110 and 112 to the through holes 130 and 132of the cut guide member 20 may secure the cut guide member 20 to thepositioning member 30, and may keep the cut guide member 20 from movingin a translational manner. Therefore, the entire A/P cutting guidedevice 10 may be secured to the quick pins 150 and 152.

It will be appreciated that the above described assembly steps are notintended to be the only manner in which the A/P cutting guide device 10may be assembled. The above is merely one example of how the A/P cuttingguide device 10 may be assembled and is not exhaustive of the manydifferent combinations that may be used to assemble the device 10 on thequick pins 150 and 152. For example, the positioning member 30 may besecured to the support member 40 prior to securing the support member 40to the quick pins 150 and 152. Other combinations may be used toassemble the A/P cutting guide device 10 on the bone without departingfrom the scope of the invention.

It should be noted that the support member 40 may be fixed to the distalfemur by way of quick pins 150 and 152. Support member 40, being a fixedmember, essentially may not move in a rotational or translational mannerrelative to the distal femur while connected to the quick pins 150 and152. However, the support member 40 may be removed from the quick pins150 and 152, and may not be permanently fixed to the quick pins 150 and152, but rather may be temporarily fixed.

It should be noted that the positioning member 30 and the cut guidemember 20 may rotate together about the support member 40, after the A/Pcutting guide device 10 has been secured to the quick pins 150 and 152which have been secured to the bone, to thereby adjust the device 10 ina rotational manner. Specifically, the rotation of the positioningmember 30 and the cut guide member 20 may be accomplished by selectivelyloosening the knob 100 to thereby release the positioning member 30 fromfixation with the support member 40, allowing the combination of thepositioning member 30 and the cut guide member 20 to rotate togetherabout a pivot. The pivot may comprise at least one of the first end 49 aand the second end 49 b of the fixed support member 40. It will beappreciated that the combination of the positioning member 30 and thecut guide member 20 may rotate within the limits of the through holes 32and 34 of the positioning member 30. After the desired rotationalmovement has occurred, the knob 100 may be tightened returning thepositioning member 30 and the cut guide member 20 to a secure positionwith the support member 40. Thus, the knob 100 may allow for theadjustment of the positioning member 30 and the cut guide member 20combination in a rotational manner. It will be appreciated that the term“pivot” as used herein may refer to at least a part of an object onwhich another object moves, depends, or turns.

The knobs 110 and 112, on the other hand, may allow adjustment of thecut guide member 20 to occur, and specifically translational movement ofthe cut guide member 20 in the anterior/posterior direction.Translational movement may be accomplished by selectively loosening theknobs 110 and 112 to thereby release the cut guide member 20 fromfixation with the positioning member 30 and the support member 40, andmoving the cut guide member 20 anteriorly or posteriorly within thelimits of the translation area 15. As noted above, the positioningmember 30 may be configured and dimensioned to reside loosely within therecessed area 22 of the cut guide member 20 such that controlledtranslational movement of the cut guide member 20 may be permitted. Inother words, the positioning member 30 and the support member 40 mayremain fixed while translational movement of the cut guide member 20occurs, such that the loose configuration of the positioning member 30within the recessed area 22 permits the cut guide member 20 to slideanteriorly or posteriorly, because the cut guide member 20 may no longerbe connected to the positioning member 30, or in other words the cutguide member 20 may be releasably attached to the positioning member 30.The cut guide member 20 may thus be able to move freely within thelimits of the translation area 15 until contact is made between the topsurface 76 or bottom surface 78 of the positioning member 30 and theanterior border 28 or the posterior border 29 of the translation area15. After the desired translational movement has occurred, the knobs 110and 112 may be tightened, securing the cut guide member 20 to thepositioning member 30 and the support member 40.

To summarize, after the A/P cutting guide device 10 has been pinned tothe bone using the quick pins 150 and 152 (illustrated best in FIGS. 4and 5), the knob 100 may be selectively loosened to permit thepositioning member 30 and the cut guide member 20 combination to moveabout the support member 40 in a limited rotational manner relative tothe support member 40 fixed to the distal femur. The knobs 110 and 112,on the other hand, may be selectively loosened to permit the cut guidemember 20 to slide in a translational manner in the anterior/posteriordirection, independent from the positioning member 30 and the fixedsupport member 40, and relative to the distal femur.

It will be appreciated that the positioning member 30 may be selectivelyreleased by the surgeon from the support member 40, and the cut guidemember 20 may be selectively released by the surgeon from thepositioning member 30. It should therefore be noted that the cut guidemember 20 and the positioning member 30 may be secured to one anothersuch that they may move together about the first end 49 a and the secondend 49 b of the support member 40, when said positioning member 30 isselectively released from said support member 40.

It should further be noted that the cut guide member 20 may be securedto the positioning member 30 such that when the cut guide member 20 isselectively released from said positioning member 30, the cut guidemember 20 may thereby be permitted to move with respect to said supportmember 40 independently from said positioning member 30. Thus, it willbe appreciated that the surgeon may selectively adjust the device 10,prior to committing to a cut in the bone, in both a rotational andtranslational manner while at least a portion of the device 10 may beanchored to the bone.

Therefore, the present invention acts as a unique A/P cutting guidedevice 10 for making anterior and posterior cuts in the distal femur toform the substantially rectangular extension and flexion gaps 16 and 18,and has the ability to move in said rotational manner and to slide insaid translational manner, relative to the quick pins 150 and 152. Itshould be noted that after the device 10 has been attached to the distalfemur by said quick pins 150 and 152, the device 10 may be adjustedrotationally and translationally without removing or replacing the quickpins 150 and 152. The device 10 may permit the surgeon to balance thesoft tissues of the knee and to make several intermittent checks duringsurgery before committing to a final posterior cut in the bone, formingthe flexion gap 18.

It will be appreciated that a device made in accordance with theprinciples of the present invention may embody more or less than theabove described structural components and need not comprise all of thestated structural components. It will be further appreciated that thedevice may not utilize the cut guide member 20, the support member 40,or the positioning member 30 as separate components, but instead maycombine one or more components into a single component, or may modifythe device to combine structural features from one component and movethat feature to another component without departing from the scope ofthe present invention. For example, the principles of the presentinvention may be applied to incorporate the function of the positioningmember 30 into a single cut guide member 20 without departing from thescope of the present invention. It should be noted that the structuralfeatures described above may be modified by one of skill in the art toprovide the same or similar functions without departing from the scopeof the invention and such modifications are therefore intended to fallwithin the scope of the present invention.

Having described the structural components of the A/P cutting guidedevice 10, several illustrative examples of how the device 10 may beadvantageously used will now be described. Referring now to FIGS. 4 and5, the flexed knee is illustrated with the A/P cutting guide device 10located on the distal end of the femur. FIG. 4 illustrates the A/Pcutting guide device 10 as being completely assembled on the distalfemur. As illustrated, the device 10 is mal-aligned on the distal femursuch that the posterior cutting surface 142 of the A/P cutting guidedevice 10, and the posterior femoral cut that would result from suchpositioning of the device 10 represented by dashed lines a-a, is notsubstantially parallel with the line created by the resection of theproximal tibia, represented by dashed lines b-b. Therefore, the distancerepresented by bracket A may be less than (as illustrated), or greaterthan, the distance represented by bracket B indicating that the twolines a-a and b-b are not substantially parallel. If the posterior cutwere made with the A/P cutting guide device 10 in this orientation, theflexion gap 18 would substantially be an imperfect rectangle, resultingin an unbalanced knee. This scenario is a common occurrence in TKAsurgeries and correctable with prior art devices by removing the quickpins and repositioning the device in an attempt to properly balance andalign the knee.

However, utilizing the A/P cutting guide device 10 of the presentinvention, the mal-alignment may be corrected without removing the quickpins 150 and 152. By loosening the knob 100, the positioning member 30and the cut guide member 20 may rotate together about the support member40, which has been fixed to the quick pins 150 and 152. Specifically, inthis scenario the device 10 may be rotated in the direction of arrow 500in FIG. 4, such that proper alignment may be achieved. Proper alignmentmay be checked using a spacer block 230 (see FIGS. 17 and 19) toidentify where the cut will be made and whether the spacer block 230will fit within the gap in the proper and desirable substantiallyrectangular alignment. It will be appreciated that the spacer block 230may have a thickness “T1” that relates to a thickness “T2” of thoseportions of the prosthetic knee implant that may be configured anddimensioned to fit within the flexion and extension gaps 18 and 16. Morespecifically, and in reference to FIG. 19, the thickness “T1” of thespacer block 230 may relate to, and may be substantially equal to, thecombined thickness “T2” of a tibial polyethylene insert 400, at least aportion of a tibial tray 405, and at least a portion of a femoralcomponent 410 (as demonstrated in FIG. 19), which may be configured tofit within the flexion and extension gaps 18 and 16. FIG. 19 illustratesthe prosthetic knee implant in an extended position, and the thickness“T2” of those portions of the prosthetic knee implant that may beinserted specifically into the extension gap 16. However, it will beappreciated that the thickness “T2” will remain substantially the samewhen the femoral component 410 moves into a flexed position (notillustrated in FIG. 19). Therefore, the thickness “T1” of the spacerblock 230 may relate to the thickness “T2” of those portions of theprosthetic knee implant that may fit within the extension and flexiongaps 16 and 18. Therefore, a spacer block 230 that fits properly withinthe flexion gap 18 and extension gap 16, will result in a prostheticknee implant that may fit properly within said gaps 18 and 16, withrespect to the thickness “T2” of those portions of the prosthetic kneeimplant that fit within the flexion gap 18 and extension gap 16.

Once proper alignment has been determined as illustrated in FIG. 5, theknob 100 may be tightened, securing the positioning member 30 and thecut guide member 20 to the support member 40. At this stage, theposterior cutting surface 142, and the resulting posterior femoral cutrepresented by dashed lines a′-a′, will be substantially parallel withthe resected portion of the proximal tibia, represented by dashed lineb′-b′. Thus, the distance represented by bracket A′ may be substantiallyequal to the distance represented by bracket B′ indicating that thelines a′-a′ and b′-b′ are substantially parallel. By making theposterior cut while the device 10 is in this orientation, therectangular flexion gap 18 will be created, ultimately resulting in aproperly balanced and aligned knee.

Referring now to FIGS. 6-18, the surgical technique and method of usingthe present invention will now be described. It will be appreciated thatthe invention will be described with reference to a TKA surgery, severalsteps of which may be familiar to one of skill in the art. Some of thepreviously known steps will be generally referred to herein, but may notbe specifically addressed.

Generally, prior to surgery a surgeon will conduct a preoperativeexamination of the patient, make a diagnosis, and make otherpreparations that may be required to assess the patient's needs. Oncethese preliminary steps have been completed, the surgeon is ready toperform the TKA surgery.

The first step of the procedure may be to expose the surgical site, bymaking an anterior midline incision, after which the joint may beentered. Thereafter, the surgeon enters the medullary canal of the femurusing a standard surgical drill 240 by drilling a hole just medial andsuperior to the center of the intercondylar notch in order to parallelthe femoral shaft, as illustrated in FIG. 6. After drilling anappropriately sized hole, the surgeon inserts a T-handle 180 into themedullary canal to decompress the marrow content. At this point thesurgeon may remove the T-handle 180 and slide it through an intramedullary (I/M) alignment guide 190, where the surgeon may set and lockthe I/M alignment guide 190 at an appropriate valgus angle, representedin FIG. 7 as the angle α. The valgus angle α may be determinedpreoperatively as part of the preparation process. FIG. 7, illustratesthe valgus angle α, and a neutral mechanical axis 2 of the limb. It willbe appreciated that the neutral mechanical axis 2 of the limb is a linethat passes from the femoral head through the center of the knee andthrough the center of the ankle. It will further be appreciated that thevalgus angle α is the angle between the neutral mechanical axis 2 of thelimb and an anatomical axis 4 of the distal femur.

More specifically and referring to FIGS. 8 and 9, after the abovepreparation takes place, a distal cut guide 200 may be assembled to adistal cut guide scaffolding 210, which results in an assembly. Theresulting assembly may be inserted into the I/M alignment guide 190 andlowered onto the anterior cortex of the femur. The distal cut guide 200may be adjusted proximally or distally in order to control the amount ofdistal femur to be resected. Adjustments may be made by rotating anadjustment knob 212, which may be located on the distal cut guidescaffolding 210, using a measurement guide 214 to view the measurementcorresponding to the amount of femur to be resected. Once theappropriate amount of distal femur to be resected has been set, thedistal cut guide 200 may be secured to the anterior cortex using a quickrelease pin driver 220 to secure quick pins 216 and 218 to the bone.After the distal cut guide 200 has been secured to the bone, theT-handle 180, I/M alignment guide 190, and the distal cut guidescaffolding 210 may be removed from the bone, leaving the distal cutguide 200 in place. Using the oscillating saw, or any other cuttinginstrument known in the art for resecting bone, the distal femur may beresected.

The next step in the procedure includes resecting a portion of theproximal tibia, by utilizing similar instrumentation used in conjunctionwith the distal resection of the femur. As generally illustrated inFIGS. 10-12, the tibial instrumentation may include a tibial alignmentguide 300, resection depth adjustment 302, a tibial cut guide 310, and atibial stylus 320 to adjust the tibia to the desired depth to beresected. The tibial alignment guide 300 may further comprise aposterior slope adjustment knob 304 and a varus (medial)/valgus(lateral) adjustment knob 306 for properly aligning the tibial cut guide310 on the tibia. Typically, the tibial resection will include about 8mm from the prominent side or 2 mm from the deficient side of the tibia.However, it will be appreciated that more or less tibia may be resecteddepending upon the anatomy and deformities present in a particularpatient. It will further be appreciated that a top surface of the tibialcut guide 310 may comprise a posterior slope between the range of about0 degrees to about 7 degrees depending upon the patient's anatomy. Aswith the femoral distal cut guide 200, after the tibial cut guide 310has been pinned to the bone, the stylus 320 may be removed and thetibial cut guide 310 utilized for resecting the tibial plateau.

The next step in the procedure includes checking the extension gap 16that has been created between the distal femoral cut and the proximaltibial cut by using the appropriately sized spacer block 230. At thisstage, ligament balancing may occur while the knee is in extension. Tobalance the ligaments, a spreader instrument (not illustrated) may beused to tense the ligaments to capacity. At this point the surgeon maysurgically cut minor nicks in the ligament to stretch the ligaments.However, care should be taken to avoid over stretching of the ligaments.Stretching of the ligaments may be performed by the surgeon until theligaments are properly balanced and the extension gap is substantiallyrectangular. When the knee is balanced, the surgeon moves onto the nextstage of the procedure. However, if the knee is not balanced,deformities may be surgically corrected using the appropriateinstrumentation until the knee is balanced. Once extension balancing hasbeen performed, the surgeon places the knee into flexion, and moves tothe next stage of the procedure.

Referring now to FIGS. 13 and 14, with the knee in flexion, the femoralcomponent may then be sized by utilizing the A/P sizing guide 60. TheA/P sizing guide 60 may be configured to be placed on the resectedportion of the distal femur such that the back side of the A/P sizingguide 60 may be seated flush with, and in the center of the resectedportion of the distal femur. At this stage, the surgeon makes note ofthe femoral component size reading indicated by markings 62. The numberon the A/P sizing guide 60 may correspond to a number located on the A/Pcut guide member 20 indicating the initial size of the femoral componentto be used, as illustrated in FIG. 16.

If the reading on the A/P sizing guide 60 indicates a marking that liesbetween sizes, the surgeon may begin by upsizing to the next largercomponent. For example, if the reading indicates a marking between size3 and size 4, a size 4 component may be used because the components canalways be downsized later. It should be noted that an increase incomponent size will result in less posterior femur being cut because ofthe space that the cut guide member 20 takes up on the distal femur.After the sizing guide 60 has been properly placed on the resectedportion of the femur, quick pins 150 and 152 may be inserted through theholes in the A/P sizing guide 60 and into the bone, securing the A/Psizing guide 60 to the distal femur. It will be appreciated that theplacement of the quick pins 150 and 152 may be a process that willaffect the placement of subsequent instrumentation, and extra attentionmay therefore be required. However, it will be appreciated that thepresent invention does not require exact placement of the quick pins 150and 152, due to the rotational and translational features describedherein.

Referring to FIGS. 15 and 16, after the femoral component has beensized, the A/P sizing guide 60 may then be removed from the quick pins150 and 152 leaving an essentially bare distal femur as illustrated inFIG. 15. FIG. 16, while not an exact replica of the A/P cutting guidedevice 10 of the present invention, illustrates six differentrepresentations of the various sizes that the cutting device 10 of thepresent invention may be made.

As illustrated, the anterior portion 12 of the device 10 may be designedsuch that its size does not change. In other words, the anterior portion12 may be configured to remain in the same location on the bone and doesnot change size. It will be appreciated that each device 10 may differwith respect to the posterior cutting surface 14. As illustrated by thedevice 10 in the number 1 position of FIG. 15, the anterior portion 12of the device 10 may maintain the same position on the distal femur, butmore or less of the posterior portion of the distal femur may beresected by choosing a larger or smaller device 10. The followingrelationship holds true for the selection of the proper size of thedevice 10. The smaller the amount of distal femur to be resected, thelarger the device 10. This relationship holds true because more of thedistal femur may be covered by a larger device 10, and therefore, lessdistal femur may be exposed for resection.

The next step in the procedure includes placing the desired size of theA/P cutting guide device 10 on the femur. This may be accomplished bythe process described above in relation to the description of thestructural features of the device 10. The process may essentiallycomprise positioning the cut guide member 20 over the quick pins 150 and152, positioning the support member 40 over the quick pins 150 and 152,placing the positioning member 30 over the quick pins 150 and 152, andsecuring the above components utilizing the knobs 100, 110 and 115.

At this stage, with the knee in flexion, the ligaments may once again betensed to capacity and rotational adjustments may then be made such thatthe A/P cutting surface may be substantially parallel with the tibialcut, as described above in relation to FIGS. 4 and 5. Briefly stated,the rotation of the device 10 may be accomplished by loosening the knob100, releasing the positioning member 30 and the cut guide member 20from the support member 40, allowing rotation of the positioning member30 and the cut guide member 20 together as a unit (illustrated best inFIG. 1).

The surgeon may then make a check of the flexion gap 18 prior tocommitting to the posterior femoral cut. This may be accomplished byusing the spacer block 230 to visually check the orientation of the A/Pcutting guide device 10 by placing the spacer block 230 on the A/Pcutting guide device 10, or next to the proximal tibial cut, todetermine whether the A/P cutting guide device 10 has been properlyaligned.

If necessary, translational adjustments may then be made. It will beappreciated that the purpose in making the posterior cut is to create aflexion gap 18 that may be substantially equal in size to the extensiongap 16, such that the ligaments will be properly balanced, whichbalancing has previously taken place. Before committing to the posteriorfemoral cut, the visual check referred to above may be used to determinewhether the spacer block 230, which generally relates to the thicknessof the prosthetic components configured to fit within the gap 18, willfit too tightly or too loosely in the flexion gap 18. If the flexion gapis too tight, then the A/P cutting guide device 10 may be movedanteriorly such that more distal femur may be cut during the posteriorcut. Conversely, if the flexion gap 18 is too loose, then the A/Pcutting guide device 10 may be moved posteriorly such that less distalfemur may be cut during the posterior resection.

Such translational movement may be accomplished as stated above, andbasically occurs by loosening the knobs 110 and 112 releasing the cutguide member 20 from the positioning member 30 and the support member40. Because the cut guide member 20 has been released from thepositioning member 30 and the support member 40, which has beenpreviously fixed to the quick pins 150 and 152, the cut guide member 20may be free to move within the confines of the translational throughholes 36 and 38 as well as within the translational area 15. At thisstage, before proceeding with the posterior cut, the A/P cutting guidedevice 10 may be positioned on the distal femur such that the flexiongap 18 will be substantially equal to the extension gap 16. Adjustmentsmay be made as necessary to accomplish such equalization.

The posterior cut may now be made using standard cutting equipment, suchas the oscillating saw mentioned above or another cutting instrument350. After the posterior cut has been made, the A/P cutting guide device10 and the quick pins 150 and 152 may be removed, and the spacer block230 may then be used to determine equality of the flexion gap 18 and theextension gap 16, as illustrated in FIG. 17. If the flexion gap 18 istoo tight, then the A/P cutting guide device 10 may be translatedanteriorly, as described above, to accommodate the resection of moreposterior distal femur, and thus increasing the flexion gap 18. If theflexion gap 18 is 4 mm too tight, then the option of downsizing to thenext smaller femoral A/P cutting guide device 10 can be selected by thesurgeon to increase the flexion gap 18. If the extension gap 16 is tootight, then resection of additional distal femoral bone will beperformed to increase the extension gap 16. The final check may then bemade using the spacer block 230 to ensure the flexion gap 18 issubstantially equal to the extension gap 16. If it becomes necessary tomake any adjustments after the check has been made, the A/P cuttingguide device 10 may be placed back on the distal femur, and the device10 rotated and/or translated until proper alignment has been achieved.At this point of the procedure, the extension gap 16 and the flexion gap18 may both be substantially rectangular and equal in size.

Finally, the surgeon finishes the cutting procedure by making the restof the femoral cuts, namely the anterior cut, and two chamfer cuts, andmay then perform a trial reduction. The surgeon then proceeds with andfinishes the remainder of the surgery.

Additionally, as part of the foregoing procedure, a first alignment rod232 may be attached to the spacer block 230 by way of a handle 234 andused to ensure that proper biomechanical alignment has been achieved asillustrated in FIG. 17. Additionally, the knee may be checked for properalignment during extension using the same spacer block 230, andattaching a second alignment rod 236 to the first alignment rod 232 andalso to the spacer block 230, as illustrated in FIG. 18.

It will be appreciated that the method and surgical steps referred toabove may be accomplished using the unique features of the device 10. Inaccordance with the features and combinations described above, a usefulmethod of surgically preparing a distal femur and a proximal tibia of apatient's knee joint to receive a prosthetic knee implant, comprises thesteps of:

-   -   (a) exposing the patient's knee joint through a standard        anterior midline incision;    -   (b) performing a distal femoral resection, including the steps        of:        -   (i) drilling a hole in the distal femur to access a            medullary canal in the femur, said hole designed to parallel            a femoral shaft of the femur in an anterolateral direction            and a mediolateral direction;        -   (ii) inserting a fluted T-handle through the opening and            into the medullary canal to decompress marrow content in the            medullary canal, removing the T-handle from said medullary            canal, sliding said T-handle through an intramedullary            alignment guide forming a first assembly, setting the            alignment guide at an appropriate valgus angle, and            inserting the first assembly into the medullary canal such            that the alignment guide contacts a prominent most femoral            condyle to thereby align the T-handle and alignment guide            with said medullary canal;        -   (iii) assembling a distal femoral cut guide to a cut guide            scaffolding forming a second assembly and inserting the            second assembly into the alignment guide until the distal            femoral cut guide contacts an anterior cortex of the femoral            condyles;        -   (iv) adjusting an amount of distal femur to be resected, and            fixing the distal femoral cut guide to the anterior cortex;        -   (v) removing the T-handle, alignment guide, and cut guide            scaffolding from the distal femur leaving only the distal            femoral cut guide; and        -   (vi) resecting the amount of distal femur using a cutting            instrument;    -   (c) performing a proximal tibial resection, including the steps        of:        -   (i) positioning a tibial alignment guide having a top and a            bottom on the patient's lower leg, positioning a tibial cut            guide on the top of the tibial alignment guide, placing a            tibial stylus on the tibial cut guide and adjusting the            tibial stylus to a desired resection depth, and lowering the            tibial cut guide onto the tibia until the tibial stylus            contacts a tibial plateau;        -   (ii) fixing the tibial cut guide to the proximal tibia and            removing the tibial stylus; and        -   (iii) resecting the tibial plateau using a cutting            instrument such that the resection is substantially            perpendicular to a tibial shaft;    -   (d) balancing an extension gap, including the steps of:        -   (i) placing a spacer block within the extension gap to check            said extension gap;        -   (ii) determining whether the extension gap is substantially            rectangular in shape; and        -   (iii) adjusting the length of the patient's ligaments using            a series of ligament releases until the extension gap is            substantially rectangular in shape;    -   (e) sizing the prosthetic femoral component with the patient's        knee in flexion, including the steps of:        -   (i) positioning a sizing guide having a femoral stylus and a            paddle by centering said sizing guide on a surface of the            distal femoral resection such that the femoral stylus of the            sizing guide contacts the anterior cortex of the femur, and            compressing the sizing guide until the paddle contacts at            least one of the femoral condyles posteriorly; and        -   (ii) reading a marking on the sizing guide corresponding to            the appropriate size prosthetic femoral component, placing a            plurality of securing members through the sizing guide and            into the distal femoral resected surface, and removing said            sizing guide from the plurality of securing members;    -   (f) locating an appropriately sized cutting guide device on the        surface of the distal femoral resection, said device comprising        a cut guide member, a support member, a positioning member, and        a plurality of attachment members, including the steps of:        -   (i) positioning the cut guide member, the support member and            the positioning member over the plurality of securing            members such that the support member may be anchored to the            distal femur via the plurality of securing members, and such            that the positioning member may be releasably secured to            said support member, and the cut guide member may be            releasably secured to said positioning member; and        -   (ii) evaluating a potential flexion gap located between the            distal femur and the proximal tibia prior to resecting a            posterior portion of the distal femur to thereby determine            if the cutting guide device is mal-aligned;    -   (g) adjusting the cutting guide device without removing any of        the plurality of securing members in a rotational manner by        loosening at least one of the plurality of attachment members        thereby releasing the positioning member and the cut guide        member from the support member such that the positioning member        and the cut guide member rotate together about the plurality of        securing members thereby rotating said cutting guide device, and        thereafter tightening said at least one of the plurality of        attachment members such that the flexion gap may be created in a        substantially parallel manner;    -   (h) checking the flexion gap with said spacer block prior to        resecting the posterior portion of the distal femur to verify        that the flexion gap is substantially equal to the extension        gap;    -   (i) adjusting the cutting guide device without removing any of        the plurality of securing members in a translational manner, if        necessary, by loosening at least one of the plurality of        attachment members thereby releasing the cut guide member from        the positioning member and the support member such that the cut        guide member may move in an anterior direction and in a        posterior direction, relative to said plurality of securing        members, and thereafter tightening said at least one of the        plurality of attachment members such that the flexion gap may be        increased or decreased to substantially equal the size of the        extension gap;    -   (j) performing a posterior distal femoral resection on a        posterior side of said distal femur creating said flexion gap,        and thereafter removing all instrumentation;    -   (k) checking said flexion gap with said spacer block to ensure        an upper side of the flexion gap is substantially parallel with        a lower side of said flexion gap, and to ensure that the flexion        gap is substantially equal to the extension gap, and to further        ensure that there is a desired fit between the spacer block, the        femur and the tibia when said spacer block is seated in said        flexion gap, and if necessary, adding the necessary        instrumentation to the plurality of securing members and        re-rotating and re-translating the instrumentation accordingly        and making any additional cuts that may be necessary until the        desired fit is obtained;    -   (l) performing a series of chamfer resections in the femur and        otherwise preparing the tibia to thereby prepare said femur and        said tibia to receive the prosthetic femoral component and the        prosthetic tibial component, respectively, such that the        patient's knee joint may be replaced;    -   (m) performing a trial reduction; and    -   (n) attaching the prosthetic femoral component and prosthetic        tibial component to their respective bones and otherwise        finishing the surgical procedure.

It will be appreciated that the structure and apparatus disclosed hereinis merely one example of a means for attaching the cut guide member 20to the support member 40, and it should be appreciated that anystructure, apparatus or system for attaching the cut guide member 20 tothe support member 40 which performs functions the same as, orequivalent to, those disclosed herein are intended to fall within thescope of a means for attaching, including those structures, apparatus orsystems for attaching the cut guide member 20 to the support member 40which are presently known, or which may become available in the future.Anything which functions the same as, or equivalently to, a means forattaching falls within the scope of this element.

It will also be appreciated that the structure and apparatus disclosedherein is merely one example of a means for rotating the cut guidemember 20 and the means for attaching, and it should be appreciated thatany structure, apparatus or system for rotating the cut guide member 20and the means for attaching which performs functions the same as, orequivalent to, those disclosed herein are intended to fall within thescope of a means for rotating, including those structures, apparatus orsystems for rotating which are presently known, or which may becomeavailable in the future. Anything which functions the same as, orequivalently to, a means for rotating falls within the scope of thiselement.

It will be appreciated that the structure and apparatus disclosed hereinis merely one example of a means for translating the device 10, and itshould be appreciated that any structure, apparatus or system fortranslating the device 10 which performs functions the same as, orequivalent to, those disclosed herein are intended to fall within thescope of a means for translating, including those structures, apparatusor systems for translating the device 10 which are presently known, orwhich may become available in the future. Anything which functions thesame as, or equivalently to, a means for translating falls within thescope of this element.

Those having ordinary skill in the relevant art will appreciate theadvantages provided by the features of the present invention. Forexample, after pinning the A/P cutting guide device 10 to the distalfemur, the positioning member 30 may be released from the support member40, permitting the positioning member 30 and the cut guide member 20 tomove together in a rotational manner relative to the support member,which has been fixed to the quick pins 150 and 152, without removing thequick pins 150 and 152 from the distal femur. It is another potentialfeature of the present invention to enable the cut guide member 20 tomove in a translational manner in the anterior/posterior directionrelative to the support member 40, which has been fixed to the quickpins 150 and 152, without removing the quick pins 150 and 152 from thedistal femur.

It is another potential feature of the present invention to provide anorthopedic A/P cutting guide device 10 which is simple in design andmanufacture. Another potential feature of the present invention is toprovide such an A/P cutting guide device 10 that is capable ofcorrecting the rotational position of the device 10 on the distal femurafter the device has been pinned to said distal femur. It is a furtherpotential feature of the present invention to provide such an A/Pcutting guide device 10 that is capable of correcting the translationalpositioning of the device 10 in the anterior/posterior direction on thedistal femur. It is another potential feature of the present inventionto provide a useful method that increases the ease and effectiveness ofsurgically resecting the posterior portion of the distal femur such thatthe flexion gap may be substantially equivalent to the extension gap,and provide for proper balancing of the ligaments in the knee joint.

It is to be understood that the above-described arrangements are onlyillustrative of the application of the principles of the presentinvention. Numerous modifications and alternative arrangements may bedevised by those skilled in the art without departing from the spiritand scope of the present invention and the patent claims are intended tocover such modifications and arrangements. Thus, while the presentinvention has been shown in the drawings and described above withparticularity and detail, it will be apparent to those of ordinary skillin the art that numerous modifications, including, but not limited to,variations in size, materials, shape, form, function and manner ofoperation, assembly and use may be made without departing from theprinciples and concepts set forth herein.

1. An orthopedic cutting guide device for use in resecting a portion ofa bone, the device comprising: a first member having a pivot, andconfigured to be anchored to the bone; a second member releasablysecured to the first member; and a cut guide member releasably securedto the second member such that the cut guide member and the secondmember move together about the pivot of the first member when saidsecond member is selectively released from said first member, whereinsaid cut guide member is further secured to said second member such thatwhen the cut guide member is selectively released from said secondmember the cut guide member is thereby permitted to move with respect tosaid first member independently from said second member; whereby asurgeon selectively adjusts the device, prior to committing to a cut inthe bone, in both a rotational and translational manner while at least aportion of the device is anchored to the bone.
 2. The orthopedic cuttingguide device of claim 1, wherein said device further comprises at leastone securing member implanted within and protruding from the bone. 3.The orthopedic cutting guide device of claim 2, wherein the first memberis anchored to the bone by the at least one securing member.
 4. Theorthopedic cutting guide device of claim 1, wherein said device furthercomprises a boom configured as a reference to aid the surgeon in makingan anterior cut in the bone, and further aids in the avoidance ofnotching the bone.
 5. The orthopedic cutting guide device of claim 4,wherein the cut guide member comprises a top surface and a bottomsurface, said top surface having an opening therein configured forreceiving a portion of the boom.
 6. The orthopedic cutting guide deviceof claim 5, wherein the boom comprises a first end and a second end, thefirst end of said boom being dimensioned to fit within the opening ofthe cut guide member and configured and dimensioned to be securedtherein.
 7. The orthopedic cutting guide device of claim 2, wherein saidfirst member comprises at least one through hole dimensioned forpermitting the at least one securing member to pass therethrough.
 8. Theorthopedic cutting guide device of claim 1, wherein said first membercomprises a top surface, a bottom surface, an outer wall, a first endand a second end, said outer wall tapering outwardly from a centralreference point toward the first end and the second end.
 9. Theorthopedic cutting guide device of claim 8, wherein said first end andsaid second end of said first member each act as the pivot, and are eachshaped in a substantially rounded configuration.
 10. The orthopediccutting guide device of claim 9, wherein the tapering of the outer wallof the first member results in a height measured between the top surfaceand the bottom surface at the central reference point that is greaterthan a height measured between the top surface and bottom surface at thefirst end and the second end.
 11. The orthopedic cutting guide device ofclaim 1, wherein said first member comprises a central through hole. 12.The orthopedic cutting guide device of claim 1, wherein said firstmember comprises a central through hole, a first side and a second side,wherein the first side and the second side each comprise a plurality ofprotrusions located medially and laterally of the central through holeof the first member for interacting with the second member and the cutguide member.
 13. The orthopedic cutting guide device of claim 12,wherein said second member comprises a plurality of through holes, andsaid cut guide member comprises a plurality of through holes, such thatthe plurality of protrusions of the first side of the first member areinserted into the plurality of through holes of the second member, andthe plurality of protrusions of the second side of the first member areinserted into plurality of through holes of the cut guide member, tothereby interact with one another during adjustment of the device. 14.The orthopedic cutting guide device of claim 1, wherein said secondmember comprises a plurality of through holes.
 15. The orthopediccutting guide device of claim 1, wherein said second member comprises acentral through hole and at least one through hole located on eitherside of the central through hole.
 16. The orthopedic cutting guidedevice of claim 1, wherein said second member comprises at least onetranslational through hole.
 17. The orthopedic cutting guide device ofclaim 16, wherein said second member comprises a first end and a secondend, and wherein said at least one translational through hole comprisesa plurality of translational through holes, and wherein at least one ofthe plurality of translational through holes is located near each of thefirst end and the second end of the second member.
 18. The orthopediccutting guide device of claim 16, wherein said at least onetranslational through hole comprises a substantially elongated shape.19. The orthopedic cutting guide device of claim 14, wherein theplurality of through holes comprises a central hole, a plurality oftranslational through holes, and a plurality of through holes locatedmedially and laterally of said central through hole.
 20. The orthopediccutting guide device of claim 15, wherein the at least one through holeis shaped in a substantially arcuate manner.
 21. The orthopedic cuttingguide device of claim 1, wherein said second member comprises a firstprotruding wall and a second protruding wall.
 22. The orthopedic cuttingguide device of claim 21, wherein said second member further comprises afirst side and a second side, wherein said first protruding wall andsaid second protruding wall both protrude outwardly from the second sideof the second member in a substantially orthogonal manner.
 23. Theorthopedic cutting guide device of claim 22, wherein said firstprotruding wall and said second protruding wall are shaped in asubstantially arcuate manner.
 24. The orthopedic cutting guide device ofclaim 1, wherein said second member comprises a series of markingscorresponding to a predetermined angle of rotation of the second member.25. The orthopedic cutting guide device of claim 1, wherein said cutguide member further comprises a recessed surface and a sidewalldefining a recessed area.
 26. The orthopedic cutting guide device ofclaim 1, wherein said cut guide member further comprises an anteriorportion and a posterior portion, said anterior portion having ananterior cutting guide and said posterior portion having a posteriorcutting guide.
 27. The orthopedic cutting guide device of claim 26,wherein said cut guide member further comprises a connecting portionlocated on the anterior side of the cut guide member, said connectingportion comprising an opening for receiving a boom therein.
 28. Theorthopedic cutting guide device of claim 12, wherein said cut guidemember further comprises a plurality of substantially elongated holesconfigured for interacting with at least one of the plurality ofprotrusions.
 29. The orthopedic cutting guide device of claim 1, whereinsaid cut guide member further comprises a plurality of receiving holes,each receiving hole configured for receiving an attachment membertherein.
 30. The orthopedic cutting guide device of claim 1, wherein thedevice further comprises an attachment member configured for releasablysecuring the second member to the first member, whereby the surgeonselectively loosens the attachment member thereby releasing said secondmember from the first member such that the second member and the cutguide member rotate together about the pivot of the first member. 31.The orthopedic cutting guide device of claim 1, wherein the devicefurther comprises at least one attachment member configured forreleasably securing the cut guide member to the second member, wherebythe surgeon selectively loosens the at least one attachment memberthereby releasing the cut guide member from the second member such thatthe cut guide member moves in said translational manner independent fromboth the second member and the first member.
 32. The orthopedic cuttingguide device of claim 1, wherein the cut guide member further comprisesan anterior cutting guide formed in an anterior portion of said cutguide member.
 33. The orthopedic cutting guide device of claim 32,wherein the anterior cutting guide slopes downwardly in a proximal todistal direction from a back surface to a front surface of the cut guidemember such that a resulting anterior cut is tapered.
 34. The orthopediccutting guide device of claim 32, wherein the anterior cutting guide isformed as a slit in the anterior portion of said cut guide member. 35.The orthopedic cutting guide device of claim 1, wherein the cut guidemember further comprises a posterior portion having a posterior cuttingguide that is configured and dimensioned as a template for making aposterior cut in the bone.
 36. The orthopedic cutting guide device ofclaim 35, wherein the posterior cutting guide comprises a substantiallyflat surface that enables a surgeon to place a cutting instrument incontact with the substantially flat surface of said posterior cuttingguide, such that a cut that is substantially straight and flat can bemade.
 37. The orthopedic cutting guide device of claim 35, wherein theposterior cutting guide is a bottom edge of the cut guide member.
 38. Anorthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a support member having a pivot, andconfigured to be anchored to the bone; a positioning member configuredto be releasably secured to the support member; and a cut guide memberconfigured to be releasably secured to the positioning member, said cutguide member and said positioning member being secured to one another,such that the cut guide member and the positioning member move togetherwhen said positioning member is selectively released from the supportmember; whereby a surgeon selectively adjusts the cut guide member andthe positioning member in a rotational manner about the pivot of thesupport member, prior to committing to a cut in the bone, while at leasta portion of the device is anchored to the bone.
 39. The orthopediccutting guide device of claim 38, wherein said device further comprisesat least one securing member implanted within and protruding from thebone.
 40. The orthopedic cutting guide device of claim 39, wherein thesupport member is anchored to the bone by the at least one securingmember.
 41. The orthopedic cutting guide device of claim 39, whereinsaid support member comprises at least one through hole for permittingthe at least one securing member to pass therethrough.
 42. Theorthopedic cutting guide device of claim 38, wherein said support membercomprises an outer wall, a first end and a second end, said outer walltapers outwardly from a central reference point toward said first endand said second end.
 43. The orthopedic cutting guide device of claim42, wherein said first end and said second end of the support membereach operate as the pivot, and are each shaped such that a substantiallyrounded configuration is achieved.
 44. The orthopedic cutting guidedevice of claim 42, wherein the tapering of the outer wall results in aheight at the central reference point that is greater than a height atthe first end and the second end.
 45. The orthopedic cutting guidedevice of claim 38, wherein said support member comprises a centralthrough hole.
 46. The orthopedic cutting guide device of claim 38,wherein said support member comprises a plurality of protrusions locatedmedially and laterally of a central through hole of the support memberconfigured for interacting with the positioning member.
 47. Theorthopedic cutting guide device of claim 46, wherein said positioningmember comprises a plurality of through holes such that the plurality ofprotrusions of the support member are inserted into the plurality ofthrough holes of the positioning member such that the plurality ofprotrusions interacts with the plurality of through holes duringrotational adjustment of the device.
 48. The orthopedic cutting guidedevice of claim 38, wherein said positioning member comprises aplurality of through holes.
 49. The orthopedic cutting guide device ofclaim 38, wherein said positioning member comprises a central throughhole and at least one through hole located on either side of the centralthrough hole on the positioning member.
 50. The orthopedic cutting guidedevice of claim 49, wherein the at least one through hole located oneither side of the central through hole is substantially shaped in anarcuate manner.
 51. The orthopedic cutting guide device of claim 48,wherein the plurality of through holes comprises a central hole, aplurality of translational through holes, and a plurality of throughholes located medially and laterally of said central through hole. 52.The orthopedic cutting guide device of claim 38, wherein saidpositioning member comprises a first protruding wall and a secondprotruding wall, and said support member comprises a first end and asecond end that each have a substantially rounded configuration.
 53. Theorthopedic cutting guide device of claim 52, wherein said positioningmember further comprises a first side and a second side, wherein saidfirst protruding wall and said second protruding wall protrude outwardlyfrom the second side of the positioning member in a substantiallyorthogonal manner.
 54. The orthopedic cutting guide device of claim 52,wherein said first protruding wall and said second protruding wall areeach shaped in a substantially arcuate manner, such that the firstprotruding wall and the second protruding wall move about thesubstantially rounded first and second ends of the support member as thedevice is rotated, moving both the positioning member and the cut guidemember together.
 55. The orthopedic cutting guide device of claim 52,wherein the positioning member further comprises a plurality ofsubstantially arcuate through holes, said first protruding wall and saidsecond protruding wall are each shaped in a substantially arcuatemanner, such that the first protruding wall and the second protrudingwall move about the substantially rounded first and second ends of thesupport member as the device is rotated, moving both the positioningmember and the cut guide member together within the confines of theplurality of substantially arcuate through holes.
 56. The orthopediccutting guide device of claim 38, wherein said positioning membercomprises a series of markings corresponding to a predetermined angle ofrotation of the positioning member.
 57. The orthopedic cutting guidedevice of claim 38, wherein the device further comprises an attachmentmember configured for releasably securing the positioning member to thesupport member, whereby the surgeon selectively loosens the attachmentmember thereby releasing said positioning member from the support membersuch that the positioning member and the cut guide member rotatetogether about the pivot of the support member.
 58. An orthopediccutting guide device for use in resecting a portion of a bone, thedevice comprising: a support member configured to be anchored to thebone; a positioning member configured to be releasably secured to thesupport member; and a cut guide member configured to be releasablysecured to the positioning member such that the cut guide member isselectively adjusted by releasing the cut guide member from saidpositioning member permitting the cut guide member to move independentlyfrom said positioning member and said support member; whereby a surgeonselectively adjusts the cut guide member in a translational manner withrespect to said support member and said positioning member, prior tocommitting to a cut in the bone, while at least a portion of the deviceis anchored to the bone.
 59. The orthopedic cutting guide device ofclaim 58, wherein said device further comprises at least one securingmember implanted within and protruding from the bone.
 60. The orthopediccutting guide device of claim 59, wherein the support member is anchoredto the bone by the at least one securing member.
 61. The orthopediccutting guide device of claim 58, wherein said device further comprisesa boom configured as a reference point to aid the surgeon in making ananterior cut in the bone, and further aids in the avoidance of notchingthe bone.
 62. The orthopedic cutting guide device of claim 61, whereinsaid cut guide member comprises a top surface and a bottom surface, saidtop surface having an opening therein configured for receiving a portionof the boom.
 63. The orthopedic cutting guide device of claim 62,wherein said boom comprises a first end and a second end, the first endof said boom being dimensioned to fit within the opening of the cutguide member.
 64. The orthopedic cutting guide device of claim 59,wherein said support member comprises at least one through hole forpermitting the at least one securing member to pass therethrough. 65.The orthopedic cutting guide device of claim 58, wherein said supportmember comprises an outer wall, a first end and a second end, said outerwall tapers outwardly from a central reference point toward said firstend and said second end.
 66. The orthopedic cutting guide device ofclaim 65, wherein said first end and said second end are each shapedsuch that a substantially rounded configuration is achieved.
 67. Theorthopedic cutting guide device of claim 66, wherein the tapering of theouter wall results in a height at the central reference point that isgreater than a height at the first end and the second end.
 68. Theorthopedic cutting guide device of claim 58, wherein said support membercomprises a central through hole.
 69. The orthopedic cutting guidedevice of claim 58, wherein said support member comprises a plurality ofprotrusions located medially and laterally of a central through hole ofthe support member configured for interacting with the cut guide member.70. The orthopedic cutting guide device of claim 69, wherein said cutguide member comprises a plurality of through holes, and wherein theplurality of protrusions of the support member are inserted into theplurality of through holes of the cut guide member, such that theplurality of protrusions interacts with the plurality of through holesof the cut guide member during adjustment of the device.
 71. Theorthopedic cutting guide device of claim 58, wherein said positioningmember comprises a plurality of through holes.
 72. The orthopediccutting guide device of claim 58, wherein said positioning membercomprises at least one translational through hole.
 73. The orthopediccutting guide device of claim 72, wherein said positioning membercomprises a first end and a second end, and wherein said at least onetranslational through hole comprises a plurality of translationalthrough holes, at least one of the plurality of translational throughholes being located at the first end and at the second end of thepositioning member.
 74. The orthopedic cutting guide device of claim 72,wherein said at least one translational through hole comprises asubstantially elongated shape.
 75. The orthopedic cutting guide deviceof claim 58, wherein said cut guide member further comprises a recessedsurface and a sidewall defining a recessed area.
 76. The orthopediccutting guide device of claim 58, wherein said cut guide member furthercomprises an anterior portion and a posterior portion, said anteriorportion having an anterior cutting guide and said posterior portionhaving a posterior cutting guide.
 77. The orthopedic cutting guidedevice of claim 76, wherein said cut guide member further comprises aconnecting portion located on the anterior side of the cut guide member,said connecting portion comprising an opening for receiving a boomtherein.
 78. The orthopedic cutting guide device of claim 69, whereinsaid cut guide member further comprises a plurality of substantiallyelongated holes configured for interacting with the plurality ofprotrusions.
 79. The orthopedic cutting guide device of claim 78,wherein said support member comprises a pivot, and wherein said cutguide member and said positioning member are secured to one another suchthat they move together when said positioning member is selectivelyreleased from the support member, whereby the surgeon selectivelyadjusts the device by moving said cut guide member and said positioningmember in a rotational manner about the pivot of the support member,such that the plurality of protrusions slide within the plurality ofsubstantially elongated holes of the cut guide member as said device isadjusted in said rotational manner, prior to the surgeon committing to acut in the bone, while at least a portion of the device is anchored tothe bone.
 80. The orthopedic cutting guide device of claim 58, whereinsaid cut guide member further comprises a plurality of receiving holes,each receiving hole configured for receiving an attachment membertherein.
 81. The orthopedic cutting guide device of claim 58, whereinthe device further comprises at least one attachment member configuredfor releasably securing the cut guide member to the positioning member,whereby the surgeon selectively loosens the at least one attachmentmember thereby releasing the cut guide member from the positioningmember such that the cut guide member moves in said translational mannerindependent from both the positioning member and the support member. 82.An orthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a support member having a pivot, andconfigured to be anchored to the bone; a positioning member configuredto be releasably secured to the support member such that the positioningmember is selectively moved with respect to the support member when saidpositioning member is released from said support member; and a cut guidemember configured to be releasably secured to the positioning member,said cut guide member and said positioning member being secured to oneanother such that they move together in a rotational manner about thepivot of the support member when said positioning member is selectivelyreleased from said support member, said cut guide member being furthersecured to said positioning member such that when the cut guide memberis selectively released from said positioning member, the cut guidemember is permitted to move in a translational manner with respect tothe support member and the positioning member; whereby a surgeonselectively adjusts the device, prior to committing to a cut in thebone, while at least a portion of the device is anchored to the bone.83. An orthopedic cutting guide device for use in resecting a portion ofa bone, the device comprising: a support member having a pivot, andconfigured for being anchored to the bone; a cut guide member configuredfor engaging the support member such that the support member engages atleast a portion of the cut guide member; and a means for attaching thecut guide member to the support member, such that the cut guide memberis secured to said means for attaching and is selectively releasablefrom said means for attaching, thus permitting the cut guide member tomove in a translational manner independent from and with respect to saidsupport member and said means for attaching when said cut guide memberis released from said means for attaching; whereby a surgeon selectivelyadjusts the device, prior to committing to a cut in the bone, while atleast a portion of the device is anchored to the bone.
 84. Theorthopedic cutting guide device of claim 83, wherein device furthercomprises a means for rotating said cut guide member and said means forattaching together about the pivot of said support member such that thedevice is rotationally adjusted.
 85. The orthopedic cutting guide deviceof claim 84, wherein said means for rotating comprises an attachmentmember configured for releasably securing the means for attaching to thesupport member, whereby the surgeon selectively loosens the attachmentmember thereby releasing said means for attaching from the supportmember such that the means for attaching and the cut guide member rotatetogether about the pivot of the support member.
 86. The orthopediccutting guide device of claim 83, wherein said means for attachingfurther comprises a first protruding wall and a second protruding wall,and a plurality of substantially elongated through holes.
 87. Theorthopedic cutting guide device of claim 83, wherein said device furthercomprises at least one attachment member configured to secure the meansfor attaching to the cut guide member, and wherein said means forattaching comprises at least one translational through hole forreceiving the at least one attachment member therethrough, whereby thesurgeon selectively loosens the at the least one attachment member, thusreleasing the cut guide member from the means for attaching and enablingthe cut guide member to move in said translational manner.
 88. Anorthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a support member having an outer surfacedefining the shape of the support member and a pivot located thereon,the support member configured for being anchored to the bone; apositioning member configured for being secured to the support member,such that the positioning member is selectively releasable from thesupport member; and a means for translating the device with respect tothe support member, said means for translating configured to be attachedto the positioning member such that the means for translating isselectively released from the positioning member permitting the meansfor translating to move independently from the support member and thepositioning member; whereby a surgeon selectively adjusts the device,prior to committing to a cut in the bone, while at least a portion ofthe device is anchored to the bone.
 89. The orthopedic cutting guidedevice of claim 88, wherein said device further comprises a means forrotating, which permits the positioning member to rotate about the pivotof the support member to adjust the device in a rotational manner. 90.The orthopedic cutting guide device of claim 88, wherein said means fortranslating comprises at least one wall surface partially defined by asidewall, said at least one wall surface defining a translation areawherein the positioning member resides, said translation area having ananterior border and a posterior border providing the limits within whichthe positioning member moves in an anterior or posterior direction tothereby translate the device relative to said support member.
 91. Theorthopedic cutting guide device of claim 88, wherein the device furthercomprises an attachment member configured to attach the means fortranslating with the positioning member, such that when the attachmentmember is selectively loosened by the surgeon, the means for translatingis released from said positioning member and permitted to move in atranslational manner with respect to said support member and saidpositioning member.
 92. An orthopedic cutting guide device for use inresecting a portion of a bone, the device comprising: a support memberreleasably secured to an end of the bone by a plurality of securingmembers; a positioning member releasably secured to the support member;and a cut guide member releasably secured to the positioning member,said cut guide member and said positioning member being secured to oneanother such that they move together when said positioning member isselectively released from said support member, wherein said cut guidemember is further secured to said positioning member, such that when thecut guide member is selectively released from said positioning memberthe cut guide member is permitted to move with respect to said supportmember independently from said positioning member; whereby a surgeonselectively adjusts the device in both a rotational and translationalmanner with respect to the end of the bone, without reattaching any ofthe plurality of securing members, prior to committing to a cut in thebone.
 93. An orthopedic cutting guide device for use in resecting aportion of a bone, the device comprising: a support member releasablysecured to an end of the bone by a plurality of securing members; apositioning member releasably secured to the support member; and a cutguide member releasably secured to the positioning member, said cutguide member and said positioning member being secured to one anothersuch that they move together when said positioning member is selectivelyreleased from the support member; whereby a surgeon selectively adjuststhe device in a rotational manner with respect to the end of the bone,without reattaching any of the plurality of securing members, prior tocommitting to a cut in the bone.
 94. An orthopedic cutting guide devicefor use in resecting a portion of a bone, the device comprising: asupport member releasably secured to an end of the bone by a pluralityof securing members; a positioning member releasably secured to thesupport member; and a cut guide member configured to be releasablysecured to the positioning member such that the cut guide member isselectively adjusted by releasing the cut guide member from saidpositioning member permitting the cut guide member to move independentlyfrom said positioning member and said support member; whereby a surgeonselectively adjusts the device in a translational manner with respect tothe end of the bone, without reattaching any of the plurality ofsecuring members, prior to committing to a cut in the bone.
 95. Anorthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a support member comprising a pivot, andconfigured and dimensioned for being secured to an end of the bone; apositioning member configured and dimensioned for being releasablysecured to the support member, and having a first side and a secondside, and further having protruding walls that protrude from the secondside such that the protruding walls articulate with the pivot of saidsupport member when said positioning member is released from saidsupport member; and a cut guide member configured and dimensioned forbeing releasably secured to the positioning member, and having arecessed surface and a sidewall defining a recessed area, said recessedarea being dimensioned for receiving therein at least a portion of saidsupport member and said positioning member such that at least a portionof said support member and at least a portion of said positioning membercontacts at least one of said recessed surface and said sidewall.
 96. Anorthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a support member having at least onethrough hole defined by a sidewall and dimensioned for receiving atleast one securing member therethrough such that the support member issecured to an end of the bone; a positioning member configured for beingsecured to said support member, and having a top surface and a bottomsurface; and a cut guide member configured for being secured to thepositioning member, the cut guide member having a face, and atranslation area, the translation area being defined by a wall surface,an anterior border, and a posterior border confining said positioningmember such that said positioning member moves freely in ananterior/posterior direction within the translation area until one ofthe top surface and the bottom surface of the positioning member movesinto contact with one of the anterior border and posterior border. 97.An orthopedic cutting guide device for use in resecting a portion of abone, the device comprising: a plurality of securing members configuredfor being inserted into and affixed to the bone; a support membercomprising a central through hole, a first end and a second end eachhaving a substantially rounded configuration and acting as a pivot, thesupport member further comprising a plurality of through holesconfigured for permitting the plurality of securing members to passtherethrough, the plurality of through holes of the support member beingdimensioned, such that the support member matingly engages and is fixedto the securing members to thereby anchor the device to the bone; apositioning member comprising a first side, a second side, and a centralthrough hole that is aligned with the central through hole of thesupport member, the positioning member further comprising at least onetranslational through hole, and at least one rotational through holelocated therein, said positioning member further comprising at least oneprotruding wall, the at least one protruding wall extending outwardlyfrom the second side of the positioning member in an orthogonal manner,wherein the at least one protruding wall has a substantially roundedconfiguration such that the at least one protruding wall interacts withand pivots around one of the first end and the second end of the supportmember, said positioning member configured for being releasably securedto the support member; a cut guide member comprising a top surface, abottom surface, and at least one receiving hole located therein that isaligned with the at least one translational through hole of thepositioning member, said cut guide member further having a recessedsurface and a sidewall defining a recessed area, said cut guide memberfurther comprising a translation area defined by an anterior border, aposterior border, and at least one wall surface that is raised withrespect to said recessed surface said cut guide member furthercomprising a plurality of through holes configured for permitting theplurality of securing members to pass therethrough and for fitting thecut guide member over the securing members, said cut guide member beingreleasably secured to the positioning member; at least one rotationalattachment member configured for passing through the central throughhole of the positioning member to be received in the central throughhole of the support member to thereby secure said positioning member tosaid support member; and at least one translational attachment memberconfigured for passing through the at least one translational throughhole of the positioning member and being received in the at least onereceiving hole of the cut guide member thus securing the cut guidemember to the positioning member; whereby loosening said at least onerotational attachment member releases the positioning member from thesupport member, such that the positioning member and the cut guidemember are selectively rotated together with respect to said securingmembers; and whereby loosening the at least one translational adjustmentmember releases the cut guide member from the positioning member suchthat the cut guide member is selectively translated with respect to thesecuring members independent from the support member and the positioningmember.
 98. The orthopedic cutting guide device of claim 97, wherein thedevice further comprises a boom having a first end and a second end,said boom being configured as a reference for a surgeon's use in makingan anterior cut in the bone, and a connecting portion located on the topsurface of the cut guide member, said connecting portion having anopening therein that is configured and dimensioned for receiving thefirst end of the boom.
 99. A method of adjusting a mal-aligned cuttingguide device on a first bone for use in resecting a portion of the firstbone, the steps comprising: evaluating a potential gap between aposterior cutting guide of the device, which is located on a distalportion of the first bone, and a proximally cut portion of a second boneutilizing a spacer block, prior to a surgeon resecting a posteriorportion of the first bone to create a flexion gap; adjusting saidmal-aligned device in a rotational manner, said device comprising a cutguide member releasably attached to a positioning member, and thepositioning member releasably attached to a support member, by releasingthe positioning member from the support member permitting thepositioning member and the cut guide member to move together in therotational manner until the posterior cutting guide and the proximallycut portion of said second bone are substantially parallel to each otherwhile at least a portion of said device is anchored to said first bone.100. The method of adjusting a mal-aligned cutting guide device of claim99, wherein the method further comprises the step of: adjusting a sizeof the potential gap in an anterior/posterior direction by releasing thecut guide member from the positioning member, while said support memberand said positioning member are anchored to the first bone, enablingsaid cut guide member to move in a translational manner independentlyfrom the support member and the positioning member.
 101. A method ofadjusting a mal-aligned cutting guide device on a first bone for use inresecting a portion of the first bone, the steps comprising:ascertaining the position of the mal-aligned device on the first bone,the device comprising a cut guide member releasably attached to apositioning member, the positioning member releasably attached to asupport member; evaluating a potential gap between a posterior portionof the cut guide member and a proximally cut portion of a second bone;and adjusting a size of the potential gap in an anterior/posteriordirection by releasing the cut guide member from the positioning member,while said support member and said positioning member are anchored tothe first bone, enabling said cut guide member to move in saidtranslational manner independently from the support member and thepositioning member.
 102. The method of adjusting the mal-aligned cuttingguide device of claim 101, wherein the method further comprises the stepof: adjusting the mal-aligned device in a rotational manner by releasingthe positioning member from the support member permitting thepositioning member and the cut guide member to move together in therotational manner until the posterior cutting guide and the proximallycut portion of said second bone are substantially parallel to each otherwhile at least a portion of said device is anchored to said first bone.103. A method of adjusting a mal-aligned cutting guide device on a firstbone for use in resecting a portion of the first bone, the stepscomprising: evaluating a potential gap between a posterior cutting guideof the device and a proximally cut portion of a second bone such thatthe device, comprising a cut guide member, a support member, and apositioning member, is adjusted in a rotational manner to create aresulting flexion gap that is substantially parallel as measured betweenthe posterior cutting guide of the device and the proximally cut portionin said second bone; adjusting said device prior to committing to aposterior cut in said first bone, while said device is anchored to thefirst bone, by loosening at least one attachment member such that thepositioning member is released from the support member while saidsupport member is anchored to the first bone, to thereby permit thepositioning member and the cut guide member to move together in saidrotational manner; and tightening said at least one attachment memberthereby attaching the positioning member to the support member such thata surgeon makes a cut in the first bone that is substantially parallelto the proximally cut portion of the second bone resulting in thesubstantially parallel flexion gap.
 104. The method of adjusting themal-aligned cutting guide device of claim 103, wherein the posteriorcutting guide of the device used in the method is located on the cutguide member.
 105. A method of adjusting a mal-aligned cutting guidedevice on a first bone for use in resecting a portion of the first bone,the steps comprising: evaluating a potential gap between the first boneand a second bone such that the mal-aligned device, comprising a cutguide member, a support member, and a positioning member, is adjusted ina translational manner relative to a distal portion of the first bone tocreate a flexion gap between a posterior portion of the cut guide memberand a proximally cut portion in said second bone, said gap being sizedfor receiving a prosthetic implant therein; adjusting the size of thegap in an anterior/posterior direction, prior to a surgeon committing toa posterior cut in said first bone, by loosening at least one attachmentmember thereby releasing the cut guide member from the positioningmember while said support member and said positioning member areanchored to the first bone, such that the cut guide member moves in saidtranslational manner independently from the support member and thepositioning member; and tightening said at least one attachment memberafter adjusting the size of the gap to a desired size thereby attachingthe cut guide member to the positioning member such that the surgeonmakes said posterior cut in the first bone.
 106. A method of adjusting amal-aligned cutting guide device on a first bone for use in resecting aportion of the first bone, the steps comprising: evaluating a gapbetween the first bone and a second bone such that the mal-aligneddevice, comprising a cut guide member, a support member, and apositioning member, is adjusted in both a rotational and translationalmanner relative to a distal portion of the first bone to create aresulting flexion gap that is substantially parallel as measured betweena posterior portion of the cut guide member and a proximally cut portionof said second bone, said flexion gap being sized for receiving aprosthetic implant therein; adjusting the device to create thesubstantially parallel flexion gap by loosening at least one of aplurality of attachment members thereby releasing the positioning memberfrom the support member, and permitting the positioning member and thecut guide member to move in said rotational manner; and furtheradjusting the device by loosening at least one of the plurality ofattachment members thereby releasing the cut guide member from saidpositioning member and said support member, and permitting the cut guidemember to move in a anterior/posterior direction in said translationalmanner.
 107. A method of assembling a cutting guide device on a bone foruse in resecting a portion of said bone, the steps comprising: insertinga plurality of securing members into the bone; placing a cut guidemember onto the securing members; anchoring a support member having aplurality of through holes to the securing members, said plurality ofthrough holes being configured and dimensioned for receiving thesecuring members therein thus securing the device to the bone; attachinga positioning member to the support member and the cut guide member,such that the positioning member is releasably attached to both thesupport member and the cut guide member; adjusting the device byloosening at least one of a plurality of attachment members therebyreleasing the positioning member from the support member permitting thepositioning member and the cut guide member to move together in arotational manner relative to the securing members; and furtheradjusting the device by loosening at least one of the plurality ofattachment members such that the cut guide member is released from thepositioning member and the support member permitting the cut guidemember to move in a translational manner relative to the securingmembers.
 108. A method of assembling a cutting guide device on a bonefor use in resecting a portion of said bone, the steps comprising:placing a cut guide member onto at least one previously implantedsecuring member, said cut guide member having at least one through holelocated therein for permitting the at least one securing member to passtherethrough; affixing a support member to the at least one securingmember, said support member having a pivot located thereon and at leastone through hole defined by a sidewall for matingly engaging the atleast one securing member such that the support member is fixed to thebone; and releasably attaching a positioning member to the supportmember and to the cut guide member such that said cut guide member andsaid positioning member move together about the pivot of the supportmember when said positioning member is selectively released from saidsupport member, and said cut guide member being secured to saidpositioning member such that when the cut guide member is selectivelyreleased from said positioning member the cut guide member is therebypermitted to move with respect to said support member independently fromsaid positioning member, whereby a surgeon selectively adjusts thedevice, prior to committing to a cut in the bone, in both a rotationaland translational manner while at least a portion of the device isanchored to the bone.
 109. A method of adjusting a cutting guide devicefor use in resecting a portion of a first bone, the steps comprising:positioning a cut guide member on the first bone; releasably securing asupport member to a plurality of securing members; releasably securing apositioning member to the cut guide member and the support member;evaluating a potential gap between a posterior portion of the cut guidemember and a proximally cut portion of a second bone to determinewhether the device is mal-aligned on the first bone, and to create aresulting gap that is substantially parallel as measured between theposterior portion of the cut guide member and the proximally cut portionof the second bone; adjusting said device in a rotational manner,without removing and reattaching the plurality of securing members,prior to a surgeon committing to a posterior cut in said first bone, byreleasing the positioning member from the support member such that thepositioning member and the cut guide member move together in saidrotational manner.
 110. A method of adjusting a cutting guide device foruse in resecting a portion of a first bone, the steps comprising:positioning a cut guide member on the first bone; releasably securing asupport member to a plurality of securing members; releasably securing apositioning member to the cut guide member and the support member;evaluating a potential gap located between a posterior portion of thecut guide member and a proximally cut portion of a second bone todetermine mal-alignment of the device such that the mal-aligned deviceis selectively adjusted to increase or decrease a size of the potentialgap between the posterior portion of the cut guide member and theproximally cut portion of the second bone; adjusting said device in atranslational manner, without removing and reattaching the plurality ofsecuring members, prior to a surgeon committing to a posterior cut insaid first bone, by releasing the cut guide member from the positioningmember such that the cut guide member moves in said translationalmanner.
 111. A method of surgically preparing a distal femur and aproximal tibia of a patient's knee joint to receive a prosthetic kneeimplant, the method comprising the steps of: (a) exposing the patient'sknee joint through a standard anterior midline incision; (b) performinga distal femoral resection, including the steps of: (i) drilling a holein the distal femur to access a medullary canal in the femur, said holedesigned to parallel a femoral shaft of the femur in an anterolateraldirection and a mediolateral direction; (ii) inserting a fluted T-handlethrough the opening and into the medullary canal to decompress marrowcontent in the medullary canal, removing the T-handle from saidmedullary canal, sliding said T-handle through an intramedullaryalignment guide forming a first assembly, setting the alignment guide atan appropriate valgus angle, and inserting the first assembly into themedullary canal such that the alignment guide contacts a prominent mostfemoral condyle to thereby align the T-handle and alignment guide withsaid medullary canal; (iii) assembling a distal femoral cut guide to acut guide scaffolding forming a second assembly and inserting the secondassembly into the alignment guide until the distal femoral cut guidecontacts an anterior cortex of the femoral condyles; (iv) adjusting anamount of distal femur to be resected, and fixing the distal femoral cutguide to the anterior cortex; (v) removing the T-handle, alignmentguide, and cut guide scaffolding from the distal femur leaving only thedistal femoral cut guide; and (vi) resecting the amount of distal femurusing a cutting instrument; (c) performing a proximal tibial resection,including the steps of: (i) positioning a tibial alignment guide havinga top and a bottom on the patient's lower leg, positioning a tibial cutguide on the top of the tibial alignment guide, placing a tibial styluson the tibial cut guide and adjusting the tibial stylus to a desiredresection depth, and lowering the tibial cut guide onto the tibia untilthe tibial stylus contacts a tibial plateau; (ii) fixing the tibial cutguide to the proximal tibia and removing the tibial stylus; and (iii)resecting the tibial plateau using a cutting instrument such that theresection is substantially perpendicular to a tibial shaft; (d)balancing an extension gap, including the steps of: (i) placing a spacerblock within the extension gap to check said extension gap; (ii)determining whether the extension gap is substantially rectangular inshape; and (iii) adjusting the length of the patient's ligaments using aseries of ligament releases until the extension gap is substantiallyrectangular in shape; (e) sizing the prosthetic femoral component withthe patient's knee in flexion, including the steps of: (i) positioning asizing guide having a femoral stylus and a paddle by centering saidsizing guide on a surface of the distal femoral resection such that thefemoral stylus of the sizing guide contacts the anterior cortex of thefemur, and compressing the sizing guide until the paddle contacts atleast one of the femoral condyles posteriorly; and (ii) reading amarking on the sizing guide corresponding to the appropriate sizeprosthetic femoral component, placing a plurality of securing membersthrough the sizing guide and into the distal femoral resected surface,and removing said sizing guide from the plurality of securing members;(f) locating an appropriately sized cutting guide device on the surfaceof the distal femoral resection, said device comprising a cut guidemember, a support member, a positioning member, and a plurality ofattachment members, including the steps of: (i) positioning the cutguide member, the support member and the positioning member over theplurality of securing members such that the support member is anchoredto the distal femur via the plurality of securing members, and such thatthe positioning member is releasably secured to said support member, andthe cut guide member is releasably secured to said positioning member;and (ii) evaluating a potential flexion gap located between the distalfemur and the proximal tibia prior to resecting a posterior portion ofthe distal femur to thereby determine if the cutting guide device ismal-aligned; (g) adjusting the cutting guide device without removing isany of the plurality of securing members in a rotational manner byloosening at least one of the plurality of attachment members therebyreleasing the positioning member and the cut guide member from thesupport member such that the positioning member and the cut guide memberrotate together about the plurality of securing members thereby rotatingsaid cutting guide device, and thereafter tightening said at least oneof the plurality of attachment members such that the flexion gap iscreated in a substantially parallel manner; (h) checking the flexion gapwith said spacer block prior to resecting the posterior portion of thedistal femur to verify that the flexion gap is substantially equal tothe extension gap; (i) adjusting the cutting guide device withoutremoving any of the plurality of securing members in a translationalmanner, if necessary, by loosening at least one of the plurality ofattachment members thereby releasing the cut guide member from thepositioning member and the support member such that the cut guide membermoves in an anterior direction and in a posterior direction, relative tosaid plurality of securing members, and thereafter tightening said atleast one of the plurality of attachment members such that the flexiongap is increased or decreased to substantially equal the size of theextension gap; (j) performing a posterior distal femoral resection on aposterior side of said distal femur creating said flexion gap, andthereafter removing all instrumentation; (k) checking said flexion gapwith said spacer block to ensure an upper side of the flexion gap issubstantially parallel with a lower side of said flexion gap, and toensure that the flexion gap is substantially equal to the extension gap,and to further ensure that there is a desired fit between the spacerblock, the femur and the tibia when said spacer block is seated in saidflexion gap, and if necessary, adding the necessary instrumentation tothe plurality of securing members and re-rotating and re-translating theinstrumentation accordingly and making any additional cuts that arenecessary until the desired fit is obtained; (l) performing a series ofchamfer resections in the femur and otherwise preparing the tibia tothereby prepare said femur and said tibia to receive the prostheticfemoral component and the prosthetic tibial component, respectively,such that the patient's knee joint is replaced; (m) performing a trialreduction; and (n) attaching the prosthetic femoral component andprosthetic tibial component to their respective bones and otherwisefinishing the surgical procedure.
 112. An orthopedic cutting guidedevice for use in resecting a portion of a bone, the device comprising:a first member having a first side, a second side, and a pivot, whereinat least one protrusion protrudes outwardly from the first side and thesecond side, wherein the first member is configured to be anchored tothe bone; a second member comprising at least one through hole definedby a sidewall, wherein the second member is releasably attached to thefirst member, and wherein the at least one protrusion of the first sideof the first member contacts the sidewall of the at least one throughhole in moveable engagement, such that the second member moves about thepivot of the first member when the second member is released from thefirst member; and a cut guide member comprising an anterior cuttingguide and a posterior cutting guide, wherein the cut guide member isreleasably attached to the second member, such that the cut guide memberand the second member move together about the pivot of the first memberin a rotational manner when said second member is selectively releasedfrom said first member, wherein said cut guide member moves in atranslational manner when the said guide member is selectively releasedfrom said second member, such that the cut guide member is permitted tomove independently from said first member and said second member;whereby a surgeon selectively adjusts the device, prior to committing toa cut in the bone, while at least a portion of the device is anchored tothe bone.